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General NPI Number Information
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NPI Number | 1750611323
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Entity Type | Organization
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Legal Business Name | CREDENCE HOME CARE AGENCY, INC
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Dates
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Enumeration Date | 01/05/2010
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 1415 N BROAD ST STE 118
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City | PHILADELPHIA
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State | PA
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Zip | 19122-3324
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Country | US
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Telephone | 215-764-5529
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Fax | 215-825-8406
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Provider Business Mailing Address
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Address Line | 1415 N BROAD ST STE 118
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City | PHILADELPHIA
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State | PA
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Zip | 19122-3324
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Country | US
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Telephone | 215-764-5529
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Fax | 215-825-8406
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. CAJETAN ONUOHA
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Credential |
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Telephone | 215-764-5529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 315964
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 31213601
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 31213601
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License Number State | PA
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