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General NPI Number Information
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NPI Number | 1831617570
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Entity Type | Organization
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Legal Business Name | COMPASSIONATE CARETAKERS HOMECARE AGENCY
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Dates
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Enumeration Date | 09/01/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2439 N COLLEGE AVE APT 5
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City | PHILADELPHIA
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State | PA
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Zip | 19121-4845
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Country | US
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Telephone | 215-420-9720
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Fax |
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Provider Business Mailing Address
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Address Line | 2439 N COLLEGE AVE UNIT 5
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City | PHILADELPHIA
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State | PA
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Zip | 19121-4845
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Country | US
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Telephone | 215-420-9720
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTENA WALLACE
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Credential | LPN
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Telephone | 215-420-9720
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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 | 34753601
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License Number State | PA
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