MEDICARE: EXURBIA 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	253Z00000X	In Home Supportive Care Agency	28713601	PA

General Provider Information

NPI Number	:	1114375433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXURBIA HOME HEALTHCARE

Provider Business Mailing Address
First Line	:	111 COVENTRY CT
Second Line	:
City	:	MONROEVILLE
State	:	PA
Zip	:	15146-3956
Country	:	US
Telephone Number	:	412-378-5482
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 LIBERTY AVE STE 1050
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15222-3771
Country	:	US
Telephone Number	:	412-378-5482
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ROBERT D WALKER SR.
Credential	:
Telephone Number	:	412-378-5482

Provider Enumeration Date	:	05/26/2016
Last Update Date	:	10/10/2017

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