MEDICARE: ISMART HOME CARE

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	163WH0200X	Home Health Registered Nurse

General Provider Information

NPI Number	:	1407634173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISMART HOME CARE

Provider Business Mailing Address
First Line	:	1121 THOMPSON AVE
Second Line	:
City	:	ROSELLE
State	:	NJ
Zip	:	07203-2810
Country	:	US
Telephone Number	:	908-445-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 S JUNIPER ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-2703
Country	:	US
Telephone Number	:	855-476-2780
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TYWAN MATA
Credential	:	MSW
Telephone Number	:	855-476-2780

Provider Enumeration Date	:	09/15/2023
Last Update Date	:	12/22/2024

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Directions to “ISMART HOME CARE ” Practice Location

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