MEDICARE: MODESTY HOME CARE 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
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1992459291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MODESTY HOME CARE LLC

Provider Business Mailing Address
First Line	:	4416 N 19TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-1002
Country	:	US
Telephone Number	:	267-770-9876
Fax Number	:

Provider Business Practice Location Address
First Line	:	4416 N 19TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-1002
Country	:	US
Telephone Number	:	267-770-9876
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AUGUSTINA DENNIS
Credential	:
Telephone Number	:	267-770-9876

Provider Enumeration Date	:	02/07/2022
Last Update Date	:	02/07/2022

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Directions to “MODESTY HOME CARE LLC ” Practice Location

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