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General NPI Number Information
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NPI Number | 1043979792
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Entity Type | Organization
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Legal Business Name | HOME CARE
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Dates
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Enumeration Date | 12/09/2021
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Last Update Date | 12/09/2021
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Provider Practice Location Address
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Address Line | 1735 FOUR MILE DR APT 12
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-1963
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Country | US
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Telephone | 717-660-3306
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Fax |
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Provider Business Mailing Address
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Address Line | 1735 FOUR MILE DR APT 12
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-1963
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Country | US
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Telephone | 717-660-3306
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Fax |
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Authorized Official
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Title or Position | HOME CARE/ OWNER
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Name | JESSICA ATIYA KATES
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Credential |
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Telephone | 717-660-3306
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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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