MEDICARE: PAT-PROVIDENCE HOME HEALTHCARE

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

General Provider Information

NPI Number	:	1093579799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAT-PROVIDENCE HOME HEALTHCARE

Provider Business Mailing Address
First Line	:	47A BYRNE CT
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-3637
Country	:	US
Telephone Number	:	330-696-4869
Fax Number	:

Provider Business Practice Location Address
First Line	:	47A BYRNE CT
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-3637
Country	:	US
Telephone Number	:	330-696-4869
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. PATRICK NICANDA ALLALA
Credential	:
Telephone Number	:	330-696-4869

Provider Enumeration Date	:	02/13/2024
Last Update Date	:	02/13/2024

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Directions to “PAT-PROVIDENCE HOME HEALTHCARE ” Practice Location

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