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General NPI Number Information
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NPI Number | 1790698967
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Entity Type | Organization
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Legal Business Name | SUPACARE COMMUNITY LIVING LLC
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Dates
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Enumeration Date | 09/28/2026
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Last Update Date | 09/28/2026
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Provider Practice Location Address
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Address Line | 2030 E TIOGA ST # 1
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City | PHILADELPHIA
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State | PA
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Zip | 19134-2634
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Country | US
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Telephone | 267-901-7482
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 N 3RD ST # 119
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City | PHILADELPHIA
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State | PA
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Zip | 19122-4425
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TYLER HUNT
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Credential |
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Telephone | 267-901-7482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | NULL
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