MEDICARE: NISSI INTEGRATED 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	:	1407646888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NISSI INTEGRATED LLC

Provider Business Mailing Address
First Line	:	25 KING AVE
Second Line	:
City	:	FOLCROFT
State	:	PA
Zip	:	19032-1023
Country	:	US
Telephone Number	:	610-905-0962
Fax Number	:

Provider Business Practice Location Address
First Line	:	621 CHESTER PIKE
Second Line	:
City	:	PROSPECT PARK
State	:	PA
Zip	:	19076-1506
Country	:	US
Telephone Number	:	610-905-4106
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JOHNSON O OYELAMI
Credential	:
Telephone Number	:	610-905-0962

Provider Enumeration Date	:	05/09/2025
Last Update Date	:	05/13/2025

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Directions to “NISSI INTEGRATED LLC ” Practice Location

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