MEDICARE: MINOVA HOME CARE AGENCY 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1619443462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINOVA HOME CARE AGENCY LLC

Provider Business Mailing Address
First Line	:	4400 O ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-6108
Country	:	US
Telephone Number	:	267-348-7950
Fax Number	:

Provider Business Practice Location Address
First Line	:	4400 O ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-6108
Country	:	US
Telephone Number	:	267-348-7950
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	THUY PHAN
Credential	:
Telephone Number	:	267-348-7950

Provider Enumeration Date	:	10/19/2018
Last Update Date	:	10/19/2018

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