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General NPI Number Information
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NPI Number | 1114789237
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Entity Type | Organization
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Legal Business Name | PINE TREE HEALTH
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Dates
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Enumeration Date | 01/24/2024
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Last Update Date | 01/24/2024
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Provider Practice Location Address
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Address Line | 6501 N 13TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19126-3604
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Country | US
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Telephone | 267-971-6128
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Fax |
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Provider Business Mailing Address
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Address Line | 6501 N 13TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19126-3604
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Country | US
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Telephone | 267-971-6128
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Fax |
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Authorized Official
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Title or Position | CO-FOUNDER
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Name | BADR WAHEED
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Credential | RN
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Telephone | 267-971-6128
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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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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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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 | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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