MEDICARE: CITIZENS HOME CARE AGENCY 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	:	1922586940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITIZENS HOME CARE AGENCY LLC

Provider Business Mailing Address
First Line	:	885 N 66TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19151-3331
Country	:	US
Telephone Number	:	215-200-1520
Fax Number	:

Provider Business Practice Location Address
First Line	:	885 N 66TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19151-3331
Country	:	US
Telephone Number	:	215-200-1520
Fax Number	:

Authorized Official
Title or Position	:	OWNER / VICE PRESIDENT
Name	:	BOSE ODUWAIYE
Credential	:
Telephone Number	:	215-200-1520

Provider Enumeration Date	:	08/01/2018
Last Update Date	:	08/01/2018

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