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General NPI Number Information
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NPI Number | 1922644145
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Entity Type | Organization
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Legal Business Name | PRUDENTIACARE HOME HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 11/22/2019
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Last Update Date | 11/22/2019
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Provider Practice Location Address
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Address Line | 1 INTERNATIONAL PLZ # 517
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City | PHILADELPHIA
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State | PA
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Zip | 19113-1510
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Country | US
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Telephone | 888-978-5109
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Fax | 888-978-5109
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Provider Business Mailing Address
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Address Line | 1 INTERNATIONAL PLZ # 517
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City | PHILADELPHIA
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State | PA
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Zip | 19113-1510
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Country | US
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Telephone | 888-978-5109
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Fax | 888-978-5109
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Authorized Official
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Title or Position | CE0
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Name | SHAVON PATTERSON
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Credential |
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Telephone | 888-978-5109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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