Provider Demographics
NPI:1013589340
Name:GREATER ETHEYLN HOMECARE
Entity Type:Organization
Organization Name:GREATER ETHEYLN HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KASEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:STARKEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:215-476-7550
Mailing Address - Street 1:644 S YEWDALL ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-2522
Mailing Address - Country:US
Mailing Address - Phone:215-608-9443
Mailing Address - Fax:
Practice Address - Street 1:644 S YEWDALL ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-2522
Practice Address - Country:US
Practice Address - Phone:215-608-9443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty