Provider Demographics
NPI:1013190768
Name:INDEPENDENT HOME CARE INC
Entity Type:Organization
Organization Name:INDEPENDENT HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUPOVLYANSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-322-4353
Mailing Address - Street 1:9892 BUSTLETON AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-2184
Mailing Address - Country:US
Mailing Address - Phone:215-322-4353
Mailing Address - Fax:215-322-4354
Practice Address - Street 1:9892 BUSTLETON AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-2184
Practice Address - Country:US
Practice Address - Phone:215-322-4353
Practice Address - Fax:215-322-4354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA39-8090Medicare PIN