MEDICARE: CENTER CITY HOME CARE, 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	:	1386294130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER CITY HOME CARE, LLC.

Provider Business Mailing Address
First Line	:	828 N HANCOCK ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19123-3028
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	828 N HANCOCK ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19123-3028
Country	:	US
Telephone Number	:	215-999-2273
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBIN GALLAGHER
Credential	:
Telephone Number	:	215-999-2273

Provider Enumeration Date	:	09/13/2019
Last Update Date	:	09/13/2019

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