MEDICARE: WILKES BARRE HOME CARE 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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1952544900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILKES BARRE HOME CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	9510 ORMSBY STATION RD
Second Line	:	STE 300
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-4081
Country	:	US
Telephone Number	:	502-891-1187
Fax Number	:	502-891-8067

Provider Business Practice Location Address
First Line	:	900 RUTTER AVENUE
Second Line	:	SUITE 8
City	:	FORTY FORT
State	:	PA
Zip	:	18704-4962
Country	:	US
Telephone Number	:	570-718-4400
Fax Number	:	570-718-4823

Authorized Official
Title or Position	:	SR VICE PRESIDENT
Name	:	PATRICK TODD LYLES
Credential	:
Telephone Number	:	502-891-1104

Provider Enumeration Date	:	04/07/2009
Last Update Date	:	01/05/2017

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