MEDICARE: HOME HEALTH AGENCY -PHILADELPHIA, 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	80300501	PA

General Provider Information

NPI Number	:	1902891195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME HEALTH AGENCY -PHILADELPHIA, LLC

Provider Business Mailing Address
First Line	:	510 HOSPITAL DR
Second Line	:	SUITE 100
City	:	MADISON
State	:	TN
Zip	:	37115-5033
Country	:	US
Telephone Number	:	615-712-2250
Fax Number	:	615-577-0081

Provider Business Practice Location Address
First Line	:	426 AIRPORT RD
Second Line	:	BELTWAY COMMONS, SUITE 138
City	:	HAZLE TOWNSHIP
State	:	PA
Zip	:	18202-3361
Country	:	US
Telephone Number	:	570-450-4050
Fax Number	:	570-450-4051

Authorized Official
Title or Position	:	MANAGER
Name	:	JORGE RICO
Credential	:
Telephone Number	:	305-476-5160

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	07/10/2012

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