=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780320259
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOMENTUM CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2022
-----------------------------------------------------
Last Update Date | 05/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 650 SENTRY PKWY STE 1
-----------------------------------------------------
City | BLUE BELL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19422-2318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-768-4735
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 650 SENTRY PKWY STE 1
-----------------------------------------------------
City | BLUE BELL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19422-2318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-768-4735
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SIMCAH LEFKOWITZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 347-768-4735
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------