Provider Demographics
NPI:1003329459
Name:LIYAH CARE HOMECARE, LLC
Entity Type:Organization
Organization Name:LIYAH CARE HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AUGUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:POMBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-963-7511
Mailing Address - Street 1:301 N. PROGRESS AVE
Mailing Address - Street 2:#C5
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109
Mailing Address - Country:US
Mailing Address - Phone:717-963-7511
Mailing Address - Fax:717-603-3667
Practice Address - Street 1:301 N. PROGRESS AVE
Practice Address - Street 2:#C5
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109
Practice Address - Country:US
Practice Address - Phone:717-963-7511
Practice Address - Fax:717-603-3664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA35033601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA35033601OtherDEPARTMENT OF HEALTH