MEDICARE: IN HOME PROGRAM

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	397588	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

General Provider Information

NPI Number	:	1275768905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IN HOME PROGRAM

Provider Business Mailing Address
First Line	:	739 N 24TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-2539
Country	:	US
Telephone Number	:	215-232-4357
Fax Number	:

Provider Business Practice Location Address
First Line	:	739 N 24TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-2539
Country	:	US
Telephone Number	:	215-232-4357
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CHRISTINA VISCO
Credential	:	RN
Telephone Number	:	215-232-4357

Provider Enumeration Date	:	05/26/2009
Last Update Date	:	05/26/2009

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Directions to “IN HOME PROGRAM ” Practice Location

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