MEDICARE: LEAD RESOURCE SERVICES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	251K00000X	Public Health or Welfare Agency
3	251S00000X	Community/Behavioral Health Agency
4	372500000X	Chore Provider
5	372600000X	Adult Companion
6	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1780401307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEAD RESOURCE SERVICES LLC

Provider Business Mailing Address
First Line	:	45 E CITY AVE UNIT 643
Second Line	:
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-2421
Country	:	US
Telephone Number	:	215-485-1609
Fax Number	:

Provider Business Practice Location Address
First Line	:	4442 RIDGE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1856
Country	:	US
Telephone Number	:	215-485-1609
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SUMAIYAH MOSS
Credential	:
Telephone Number	:	215-485-1609

Provider Enumeration Date	:	09/24/2024
Last Update Date	:	09/24/2024

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Directions to “LEAD RESOURCE SERVICES LLC ” Practice Location

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