MEDICARE: IN HOME PROGRAM, INC.

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	164W00000X	Licensed Practical Nurse	758805	PA
2	251J00000X	Nursing Care Agency	758805	PA
3	251E00000X	Home Health Agency	758805	PA

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
2	758805	OTHER	PA	LICENSE

General Provider Information

NPI Number	:	1255662482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IN HOME PROGRAM, INC.

Provider Business Mailing Address
First Line	:	739 N 24TH ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19130-2539
Country	:	US
Telephone Number	:	215-763-2265
Fax Number	:	215-763-4146

Provider Business Practice Location Address
First Line	:	739 N 24TH ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19130-2539
Country	:	US
Telephone Number	:	215-763-2265
Fax Number	:	215-763-4146

Authorized Official
Title or Position	:	CEO
Name	:	MR. PAUL E. MACDONALD
Credential	:
Telephone Number	:	215-763-2265

Provider Enumeration Date	:	01/28/2010
Last Update Date	:	01/28/2010

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