MEDICARE: BIENNE BASTIA

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	251E00000X	Home Health Agency	24693601	PA

General Provider Information

NPI Number	:	1093128167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BIENNE BASTIA

Provider Business Mailing Address
First Line	:	3222 W CHELTENHAM AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150-1003
Country	:	US
Telephone Number	:	484-468-1493
Fax Number	:	888-910-7765

Provider Business Practice Location Address
First Line	:	3222 W CHELTENHAM AVE STE B-1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150-1003
Country	:	US
Telephone Number	:	484-468-1493
Fax Number	:	888-910-7765

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

Provider Enumeration Date	:	06/06/2014
Last Update Date	:	06/06/2014

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Directions to “ BIENNE BASTIA ” Practice Location

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