=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417656802
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EASY CARE HEALTH CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2023
-----------------------------------------------------
Last Update Date | 05/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4629 OLD YORK RD
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19140-1221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-403-7406
-----------------------------------------------------
Fax | 215-403-7406
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4629 OLD YORK RD
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19140-1221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-403-7406
-----------------------------------------------------
Fax | 215-403-7406
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | MISS TANISHA MICHELE CLAYTON
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 267-325-0221
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------