Provider Demographics
NPI:1114319456
Name:FORT HOME CARE AGENCY LLC
Entity Type:Organization
Organization Name:FORT HOME CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:YURIY
Authorized Official - Middle Name:
Authorized Official - Last Name:REDTSCHITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-776-2459
Mailing Address - Street 1:449 VEIT RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-1617
Mailing Address - Country:US
Mailing Address - Phone:215-776-2459
Mailing Address - Fax:484-732-2030
Practice Address - Street 1:449 VEIT RD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-1617
Practice Address - Country:US
Practice Address - Phone:215-776-2459
Practice Address - Fax:484-732-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-24
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA22943601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care