Provider Demographics
NPI:1093258121
Name:JAVA HOME CARE, INC.
Entity Type:Organization
Organization Name:JAVA HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHAREHOLDER
Authorized Official - Prefix:
Authorized Official - First Name:NAANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-921-3043
Mailing Address - Street 1:6544 WOODLAND AVE
Mailing Address - Street 2:1ST FLR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19142-2215
Mailing Address - Country:US
Mailing Address - Phone:215-921-3043
Mailing Address - Fax:
Practice Address - Street 1:6544 WOODLAND AVE
Practice Address - Street 2:1ST FLR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19142-2215
Practice Address - Country:US
Practice Address - Phone:215-921-3043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA31833601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA31833601Medicaid