MEDICARE: TANETTA POLES/ATTAHER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide		PA
2	251E00000X	Home Health Agency	95627982	PA

General Provider Information

NPI Number	:	1083090377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANETTA POLES/ATTAHER

Provider Business Mailing Address
First Line	:	5504 WESTFORD RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-2642
Country	:	US
Telephone Number	:	610-209-2731
Fax Number	:

Provider Business Practice Location Address
First Line	:	5504 WESTFORD RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-2642
Country	:	US
Telephone Number	:	610-209-2731
Fax Number	:	610-314-0960

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2015
Last Update Date	:	03/16/2016

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Directions to “ TANETTA POLES/ATTAHER ” Practice Location

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