MEDICARE: GREATER LOVE HOME HEALTH CARE INC

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		PA

General Provider Information

NPI Number	:	1417323510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER LOVE HOME HEALTH CARE INC

Provider Business Mailing Address
First Line	:	8600 W CHESTER PIKE STE 308
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-2629
Country	:	US
Telephone Number	:	484-454-5529
Fax Number	:

Provider Business Practice Location Address
First Line	:	8600 W CHESTER PIKE STE 308
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-2629
Country	:	US
Telephone Number	:	484-454-5529
Fax Number	:

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	AUGIE WALLACE
Credential	:
Telephone Number	:	267-570-0472

Provider Enumeration Date	:	08/12/2015
Last Update Date	:	12/06/2018

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