=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467926493
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAMECUED UNLIMITED LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2019
-----------------------------------------------------
Last Update Date | 01/12/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1367 ANCHOR ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19124-1203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-648-2708
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6455 N BROAD ST APT 204
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19126-3628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-816-6864
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CHRISTEN M MCLEOD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-648-2708
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------