MEDICARE: JIREH HOMEHEALTH AGENCY

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

General Provider Information

NPI Number	:	1609128305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JIREH HOMEHEALTH AGENCY

Provider Business Mailing Address
First Line	:	1315 WALNUT ST
Second Line	:	SUITE 1326
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4719
Country	:	US
Telephone Number	:	215-735-7702
Fax Number	:	215-735-7703

Provider Business Practice Location Address
First Line	:	1315 WALNUT ST
Second Line	:	SUITE 1326
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4719
Country	:	US
Telephone Number	:	215-735-7702
Fax Number	:	215-735-7703

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. LEWIS P. HANNAH
Credential	:
Telephone Number	:	215-735-7702

Provider Enumeration Date	:	10/05/2012
Last Update Date	:	10/05/2012

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