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General NPI Number Information
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NPI Number | 1518681329
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Entity Type | Organization
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Legal Business Name | IMMENSELY DEDICATED HEALTHCARE LLC
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Dates
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Enumeration Date | 09/27/2022
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Last Update Date | 09/27/2022
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Provider Practice Location Address
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Address Line | 2109 FOSTER AVE CIR
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City | BRISTOL
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State | PA
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Zip | 19007
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Country | US
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Telephone | 215-806-6476
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Fax |
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Provider Business Mailing Address
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Address Line | 1331 LINCOLN HWY # 152
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City | LEVITTOWN
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State | PA
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Zip | 19056-1135
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Country | US
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Telephone | 215-806-6476
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JESSICA PUGH
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Credential |
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Telephone | 215-806-6476
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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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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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