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General NPI Number Information
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NPI Number | 1063020444
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Entity Type | Organization
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Legal Business Name | M&I HOMECARE AND COMMUNITY SERVICES
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Dates
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Enumeration Date | 07/21/2020
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Last Update Date | 07/21/2020
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Provider Practice Location Address
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Address Line | 51 LONG LN
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City | UPPER DARBY
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State | PA
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Zip | 19082-2507
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Country | US
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Telephone | 267-688-3228
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Fax |
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Provider Business Mailing Address
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Address Line | 51 LONG LN
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City | UPPER DARBY
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State | PA
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Zip | 19082-2507
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Country | US
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Telephone | 267-250-8637
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. CYNTHIA OKEBATA
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Credential |
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Telephone | 267-250-8637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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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 | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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