MEDICARE: CAMPBELL CARE HOMECARE AGENCY 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
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1376154120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMPBELL CARE HOMECARE AGENCY LLC

Provider Business Mailing Address
First Line	:	3026 N 26TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132-1203
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3026 N 26TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132-1203
Country	:	US
Telephone Number	:	267-808-0756
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CASHAE CAMPBELL
Credential	:
Telephone Number	:	267-808-0756

Provider Enumeration Date	:	08/14/2020
Last Update Date	:	08/14/2020

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