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General NPI Number Information
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NPI Number | 1003356452
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Entity Type | Organization
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Legal Business Name | PERSONAL CARE HOME C&G, INC
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Dates
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Enumeration Date | 03/05/2017
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Last Update Date | 03/03/2022
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Provider Practice Location Address
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Address Line | 4104 N 5TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19140-2614
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Country | US
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Telephone | 215-223-0200
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Fax |
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Provider Business Mailing Address
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Address Line | 6176 NEWTOWN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19111-5928
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Country | US
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Telephone | 267-978-3040
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | SAMUEL QUARTEY
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Credential | PDM
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Telephone | 215-471-1407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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