MEDICARE: CLP HOME 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	251J00000X	Nursing Care Agency	PN093291L	PA

General Provider Information

NPI Number	:	1154692044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLP HOME HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	204 STEVENS ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-5917
Country	:	US
Telephone Number	:	215-459-2733
Fax Number	:

Provider Business Practice Location Address
First Line	:	2722 N RINGGOLD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132-3208
Country	:	US
Telephone Number	:	215-221-6060
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. PAMELA E TAYLOR
Credential	:
Telephone Number	:	215-459-2733

Provider Enumeration Date	:	01/24/2012
Last Update Date	:	01/24/2012

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