MEDICARE: MCMANUS ASSISTIVE 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	253Z00000X	In Home Supportive Care Agency		PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	33143601	OTHER	PA	STATE LICENSE

General Provider Information

NPI Number	:	1487188876
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCMANUS ASSISTIVE CARE INC

Provider Business Mailing Address
First Line	:	2336 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-4417
Country	:	US
Telephone Number	:	267-607-3659
Fax Number	:	215-334-0300

Provider Business Practice Location Address
First Line	:	2336 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-4417
Country	:	US
Telephone Number	:	267-607-3659
Fax Number	:	215-334-0300

Authorized Official
Title or Position	:	DIRECTOR
Name	:	IRA J MCMANUS
Credential	:	R.N.
Telephone Number	:	267-607-3659

Provider Enumeration Date	:	04/12/2017
Last Update Date	:	03/13/2019

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