MEDICARE: WATCHFUL HOMECARE ORGANIZATION 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	:	1326789942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WATCHFUL HOMECARE ORGANIZATION LLC

Provider Business Mailing Address
First Line	:	2441 JASPER ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-1231
Country	:	US
Telephone Number	:	267-257-5731
Fax Number	:

Provider Business Practice Location Address
First Line	:	2441 JASPER ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-1231
Country	:	US
Telephone Number	:	267-257-5731
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT/ADMINISTRATOR
Name	:	SELUA JONNY
Credential	:
Telephone Number	:	267-257-5731

Provider Enumeration Date	:	04/06/2022
Last Update Date	:	04/06/2022

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