MEDICARE: PATRIOTCARE HOME SERVICES

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184076655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATRIOTCARE HOME SERVICES

Provider Business Mailing Address
First Line	:	1700 MARKET ST
Second Line	:	SUITE 1005
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-3913
Country	:	US
Telephone Number	:	302-465-2261
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 MARKET ST
Second Line	:	SUITE 1005
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-3913
Country	:	US
Telephone Number	:	302-465-2261
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MISS SUEDUKA GIBBS
Credential	:	MBA
Telephone Number	:	302-465-2261

Provider Enumeration Date	:	07/08/2016
Last Update Date	:	07/08/2016

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