MEDICARE: SELBY HEALTH SYSTEMS, 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1184286098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SELBY HEALTH SYSTEMS, LLC

Provider Business Mailing Address
First Line	:	1 BARKSTON WAY
Second Line	:
City	:	NEW CASTLE
State	:	DE
Zip	:	19720-8846
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2240 W HUNTINGDON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132-3622
Country	:	US
Telephone Number	:	215-203-4868
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VELECIA SELBY
Credential	:
Telephone Number	:	302-326-1309

Provider Enumeration Date	:	07/01/2019
Last Update Date	:	07/01/2019

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