Provider Demographics
NPI:1003480971
Name:PRUDENTIAL HOME HEALTHCARE
Entity Type:Organization
Organization Name:PRUDENTIAL HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DON
Authorized Official - Prefix:
Authorized Official - First Name:LEAHMON
Authorized Official - Middle Name:E
Authorized Official - Last Name:GAYE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:484-840-6969
Mailing Address - Street 1:13 WATSON LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-9387
Mailing Address - Country:US
Mailing Address - Phone:484-840-6969
Mailing Address - Fax:
Practice Address - Street 1:13 WATSON LN
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-9387
Practice Address - Country:US
Practice Address - Phone:484-840-6969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-16
Last Update Date:2021-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health