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General NPI Number Information
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NPI Number | 1750730586
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Entity Type | Organization
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Legal Business Name | PROVISIONS HOME HEALTHCARE SERVICES,LLC
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Dates
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Enumeration Date | 06/13/2016
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Last Update Date | 06/13/2016
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Provider Practice Location Address
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Address Line | 10067 SANDMEYER LN SUITE 212
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City | PHILADELPHIA
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State | PA
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Zip | 19116-3533
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Country | US
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Telephone | 215-399-9766
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Fax |
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Provider Business Mailing Address
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Address Line | 10067 SANDMEYER LN SUITE 212
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City | PHILADELPHIA
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State | PA
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Zip | 19116-3533
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Country | US
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Telephone | 215-399-9766
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JENNIFER CLERISSON
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Credential | RN BSN
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Telephone | 215-399-9766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 30023601
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License Number State | PA
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