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General NPI Number Information
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NPI Number | 1033933387
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Entity Type | Organization
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Legal Business Name | PHOENIX RURAL HOME HEALTH OF PA
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 730 ERIE AVE
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City | RENOVO
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State | PA
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Zip | 17764-1130
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Country | US
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Telephone | 570-243-1006
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Fax | 570-858-0041
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Provider Business Mailing Address
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Address Line | 730 ERIE AVE
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City | RENOVO
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State | PA
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Zip | 17764-1130
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Country | US
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Telephone | 570-243-1006
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Fax | 570-858-0041
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Authorized Official
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Title or Position | DIRECTOR OF NURSING
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Name | MRS. NICOLE GIPE WERTS
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Credential | RN
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Telephone | 570-295-6519
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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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