MEDICARE: TANYA'S HOMECARE SERVICES 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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1659242840
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TANYA'S HOMECARE SERVICES LLC

Provider Business Mailing Address
First Line	:	45 E CITY AVE # 1558
Second Line	:
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-2421
Country	:	US
Telephone Number	:	445-285-1674
Fax Number	:	445-285-1674

Provider Business Practice Location Address
First Line	:	104 S 20TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-4410
Country	:	US
Telephone Number	:	445-285-1674
Fax Number	:	445-285-1674

Authorized Official
Title or Position	:	OWNER
Name	:	DOMINIQUE VIOLA BUSSEY
Credential	:
Telephone Number	:	445-285-1674

Provider Enumeration Date	:	09/12/2025
Last Update Date	:	09/12/2025

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