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General NPI Number Information
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NPI Number | 1467071118
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Entity Type | Organization
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Legal Business Name | HEALTHY AGING HOME CARE AGENCY
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Dates
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Enumeration Date | 04/13/2020
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Last Update Date | 04/13/2020
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Provider Practice Location Address
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Address Line | 3009 N FRONT ST
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City | PHILADELPHIA
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State | PA
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Zip | 19133-4202
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Country | US
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Telephone | 267-225-2284
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Fax |
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Provider Business Mailing Address
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Address Line | 253 DELMAR ST
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City | PHILADELPHIA
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State | PA
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Zip | 19128-4502
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | KELVINA COLES
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Credential | RRT
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Telephone | 267-225-2284
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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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