=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720081680
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IN HOME PROGRAM, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2005
-----------------------------------------------------
Last Update Date | 08/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 739 N. 24TH STREET
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-232-4357
-----------------------------------------------------
Fax | 215-763-0708
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 739 N. 24TH STREET
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-232-4357
-----------------------------------------------------
Fax | 215-763-0708
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DAVID HATOOKA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-378-4122
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 758805
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 397588
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------