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General NPI Number Information
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NPI Number | 1003627142
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Entity Type | Organization
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Legal Business Name | BCC PERSONAL CARE HOME LLC
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Dates
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Enumeration Date | 01/17/2025
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 205 KREWSON TER
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City | WILLOW GROVE
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State | PA
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Zip | 19090-3517
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Country | US
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Telephone | 215-494-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 205 KREWSON TER
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City | WILLOW GROVE
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State | PA
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Zip | 19090-3517
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Country | US
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Telephone | 215-494-0100
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MR. PATRICK DEMETRY CHARLES
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Credential |
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Telephone | 215-494-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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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 | 174200000X
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Taxonomy Name | Meals Provider
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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 | 311Z00000X
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Taxonomy Name | Custodial Care 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 | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number |
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License Number State |
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Taxonomy #5
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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 #6
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Taxonomy Code | 343800000X
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Taxonomy Name | Secured Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 372500000X
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Taxonomy Name | Chore Provider
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #13
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Taxonomy Code | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number |
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License Number State |
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Taxonomy #14
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State |
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Taxonomy #15
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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