=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033450069
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 99 ADULT DAY CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2013
-----------------------------------------------------
Last Update Date | 03/15/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1019 CHERRY ST FL 1
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19107-2312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-966-2175
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1019 CHERRY ST FL 1
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19107-2312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-966-2175
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. MARCUS H LUK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-966-2175
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 315084
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------