Provider Demographics
NPI:1083252563
Name:TYLEYNE'S GROUP, LLC.
Entity Type:Organization
Organization Name:TYLEYNE'S GROUP, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO-OPERATION
Authorized Official - Prefix:
Authorized Official - First Name:LEIGHMON
Authorized Official - Middle Name:N
Authorized Official - Last Name:EISENHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-394-2548
Mailing Address - Street 1:832 GREENWICH ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601-3176
Mailing Address - Country:US
Mailing Address - Phone:484-394-2548
Mailing Address - Fax:484-513-3808
Practice Address - Street 1:832 GREENWICH ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-3176
Practice Address - Country:US
Practice Address - Phone:484-394-2548
Practice Address - Fax:484-513-3808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103703956Medicaid