MEDICARE: MICAH HEALTH SERVICES LLC

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	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1124703731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICAH HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	313 S STATE RD
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-3534
Country	:	US
Telephone Number	:	484-764-1928
Fax Number	:

Provider Business Practice Location Address
First Line	:	313 S STATE RD
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-3534
Country	:	US
Telephone Number	:	484-764-1928
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. KATON BELL
Credential	:
Telephone Number	:	484-764-1928

Provider Enumeration Date	:	06/20/2023
Last Update Date	:	06/20/2023

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Directions to “MICAH HEALTH SERVICES LLC ” Practice Location

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