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General NPI Number Information
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NPI Number | 1023704798
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Entity Type | Organization
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Legal Business Name | CLEMENTINE HOME HEALTH CARE, LLC
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Dates
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Enumeration Date | 04/14/2023
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Last Update Date | 07/17/2023
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Provider Practice Location Address
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Address Line | 63 W LANCASTER AVE STE 14
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City | ARDMORE
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State | PA
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Zip | 19003-1413
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Country | US
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Telephone | 267-259-2911
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Fax |
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Provider Business Mailing Address
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Address Line | 333 E LANCASTER AVE STE 417
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City | WYNNEWOOD
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State | PA
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Zip | 19096-1929
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Country | US
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Telephone | 267-259-2911
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TEHSEEN A KHAN
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Credential |
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Telephone | 267-259-2911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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