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General NPI Number Information
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NPI Number | 1831919778
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Entity Type | Organization
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Legal Business Name | PERSONAL CARE HOME C&G MEDICAL CLINIC, PLLC
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 4104 N 5TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19140-2614
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Country | US
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Telephone | 445-223-3812
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Fax | 445-223-1770
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Provider Business Mailing Address
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Address Line | 4104 N 5TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19140-2614
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Country | US
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Telephone | 445-223-3812
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Fax | 445-223-1770
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | KARIMA PARSON-WRIGHT
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Credential |
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Telephone | 445-223-3812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2472R0900X
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Taxonomy Name | Renal Dialysis Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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