MEDICARE: OUR FAMILY IS YOUR FAMILY , 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1275350670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUR FAMILY IS YOUR FAMILY , LLC

Provider Business Mailing Address
First Line	:	846 N 63RD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19151-3443
Country	:	US
Telephone Number	:	215-388-5338
Fax Number	:

Provider Business Practice Location Address
First Line	:	846 N 63RD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19151-3443
Country	:	US
Telephone Number	:	215-388-5338
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LATAEZYA JOHNSON
Credential	:
Telephone Number	:	215-388-5338

Provider Enumeration Date	:	09/25/2024
Last Update Date	:	11/27/2024

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Directions to “OUR FAMILY IS YOUR FAMILY , LLC ” Practice Location

Language	Start Address	Practice Location

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