=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629874805
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SULLIVAN HOME HEALTHCARE AGENCY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2025
-----------------------------------------------------
Last Update Date | 02/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 TOWNSHIP LINE RD APT 3
-----------------------------------------------------
City | ROCKLEDGE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19046-5127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-230-7897
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8001 CASTOR AVE # 151
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19152-2742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-230-7897
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | MS. NAKIA NEAL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 267-230-7897
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------