=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700335486
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARTNERS IN CARE AT HOME LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2016
-----------------------------------------------------
Last Update Date | 09/23/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 850 WEST CHESTER PIKE
-----------------------------------------------------
City | HAVERTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19083-4400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-747-0309
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 512 N 67TH STREET
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19151-3610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-747-0309
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | SNELL GRAND-PIERRE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-747-0309
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 30733601
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------