MEDICARE: EMMANUEL'S PROFESSIONAL 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1861007304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMMANUEL'S PROFESSIONAL SERVICES LLC

Provider Business Mailing Address
First Line	:	624 LEVICK ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-5738
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6009 TORRESDALE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19135-3715
Country	:	US
Telephone Number	:	267-388-6941
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR/PRESIDENT
Name	:	BEAUBRUN EMMANUEL
Credential	:
Telephone Number	:	267-498-8919

Provider Enumeration Date	:	09/11/2020
Last Update Date	:	09/11/2020

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