MEDICARE: HOME HEALTH AGENCY - PENNSYLVANIA, 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	77670501	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922092774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME HEALTH AGENCY - PENNSYLVANIA, LLC

Provider Business Mailing Address
First Line	:	PO BOX 51266
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70505-1266
Country	:	US
Telephone Number	:	800-489-1307
Fax Number	:	337-233-5764

Provider Business Practice Location Address
First Line	:	6000 TOWN CENTER BLVD STE 325
Second Line	:
City	:	CANONSBURG
State	:	PA
Zip	:	15317-5841
Country	:	US
Telephone Number	:	412-276-5030
Fax Number	:	412-276-5937

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOSHUA L PROFFITT
Credential	:
Telephone Number	:	337-233-1307

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	05/24/2024

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