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General NPI Number Information
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NPI Number | 1639688872
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Entity Type | Organization
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Legal Business Name | CITIZEN HOME CARE AGENCY LLC
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Dates
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Enumeration Date | 09/20/2017
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Last Update Date | 09/20/2017
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Provider Practice Location Address
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Address Line | 605 LOUIS DR STE 504
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City | WARMINSTER
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State | PA
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Zip | 18974-2830
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Country | US
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Telephone | 267-242-2070
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Fax |
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Provider Business Mailing Address
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Address Line | 100 SOUTH BROAD STREET SUITE 815
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City | PHILADELPHIA
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State | PA
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Zip | 19110
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Country | US
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Telephone | 267-930-7633
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Fax | 267-457-3922
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Authorized Official
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Title or Position | MANAGING MEMBER/PRESIDENT
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Name | AZARYA YAKUBOV
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Credential |
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Telephone | 267-242-2070
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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 | 34703601
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License Number State | PA
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