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General NPI Number Information
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NPI Number | 1164875696
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Entity Type | Organization
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Legal Business Name | WHITE LILY HOME CARE INC
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Dates
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Enumeration Date | 07/20/2016
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Last Update Date | 10/15/2019
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Provider Practice Location Address
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Address Line | 4915 WYNNEFIELD AVENUE 1AF
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City | WYNNEFIELD HEIGHTS
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State | PA
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Zip | 19131
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Country | US
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Telephone | 215-874-7444
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Fax |
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Provider Business Mailing Address
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Address Line | 4915 WYNNEFIELD AVENUE 1AF
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City | WYNNEFIELD HEIGHTS
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State | PA
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Zip | 19131
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Country | US
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Telephone | 215-874-7444
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/ADMINISTRATOR
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Name | MS. MARIE TONDALAYA CLACK
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Credential | LPN, BA
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Telephone | 215-874-7444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 30513601
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License Number State | PA
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