MEDICARE: OUR HEART HOME CARE

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	30103601	PA

General Provider Information

NPI Number	:	1760836456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUR HEART HOME CARE

Provider Business Mailing Address
First Line	:	62 CEDAR HILL LN
Second Line	:
City	:	MEDIA
State	:	PA
Zip	:	19063-6311
Country	:	US
Telephone Number	:	215-309-3885
Fax Number	:

Provider Business Practice Location Address
First Line	:	2250 RIDGE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-2930
Country	:	US
Telephone Number	:	215-309-3885
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. SURINDERPAL SINGH GILL
Credential	:
Telephone Number	:	215-309-3885

Provider Enumeration Date	:	04/19/2016
Last Update Date	:	06/03/2021

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