=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811201395
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JERRILYN HEALTH CARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2010
-----------------------------------------------------
Last Update Date | 07/27/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6628 WOODLAND AVENUE LOWER LEVEL
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-254-4551
-----------------------------------------------------
Fax | 215-739-1239
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6628 WOODLAND AVE LOWER LEVEL
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19142-2223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-254-4551
-----------------------------------------------------
Fax | 215-379-1239
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | JERRY KORLUBAH YOGBOH SR.
-----------------------------------------------------
Credential | MS
-----------------------------------------------------
Telephone | 267-254-4551
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------