MEDICARE: TAHIRA WILSON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	385H00000X	Respite Care
3	251T00000X	PACE Provider Organization
4	372500000X	Chore Provider
5	372600000X	Adult Companion
6	3747A0650X	Attendant Care Provider
7	3747P1801X	Personal Care Attendant
8	376J00000X	Homemaker
9	251B00000X	Case Management Agency
10	251E00000X	Home Health Agency
11	251G00000X	Community Based Hospice Care Agency
12	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629677182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAHIRA WILSON RN

Provider Business Mailing Address
First Line	:	1925 KEITH RD UNIT 9
Second Line	:
City	:	ABINGTON
State	:	PA
Zip	:	19001-2628
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1521 66TH AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19126-2766
Country	:	US
Telephone Number	:	215-237-6439
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2020
Last Update Date	:	10/25/2020

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