=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063988160
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATRIOT HOME CARE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2018
-----------------------------------------------------
Last Update Date | 10/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 239 4TH AVE STE 1005
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15222-1706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-274-8080
-----------------------------------------------------
Fax | 412-235-7419
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5700 N BROAD ST STE 3
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19141-2324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-535-5550
-----------------------------------------------------
Fax | 267-871-8028
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | VOLODYMIR MATKIVSKI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 877-535-5550
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------