=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144608423
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOTHER/DAUGHTER HOME CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2015
-----------------------------------------------------
Last Update Date | 05/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2151 E HIGH ST SUITE A
-----------------------------------------------------
City | POTTSTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19464-3289
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-906-1924
-----------------------------------------------------
Fax | 484-624-5217
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2151 E HIGH ST SUITE A
-----------------------------------------------------
City | POTTSTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19464-3289
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-906-1924
-----------------------------------------------------
Fax | 484-624-5217
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | ALYCIA WERTMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 610-906-1924
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 14363601
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------