MEDICARE: MODEST HOME CARE 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
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1790311827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MODEST HOME CARE LLC

Provider Business Mailing Address
First Line	:	1308 W WALNUT ST
Second Line	:
City	:	COAL TOWNSHIP
State	:	PA
Zip	:	17866-1310
Country	:	US
Telephone Number	:	267-228-2921
Fax Number	:

Provider Business Practice Location Address
First Line	:	1308 W WALNUT ST
Second Line	:
City	:	COAL TOWNSHIP
State	:	PA
Zip	:	17866-1310
Country	:	US
Telephone Number	:	267-228-2921
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LUIS CORDERO
Credential	:
Telephone Number	:	267-228-2921

Provider Enumeration Date	:	03/20/2020
Last Update Date	:	03/20/2020

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