Provider Demographics
NPI:1124586870
Name:AFFORDABLE HOME CARE LLC
Entity Type:Organization
Organization Name:AFFORDABLE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUR
Authorized Official - Suffix:
Authorized Official - Credentials:CPA, CTP
Authorized Official - Phone:267-614-1696
Mailing Address - Street 1:928 RACE ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-2437
Mailing Address - Country:US
Mailing Address - Phone:215-372-0100
Mailing Address - Fax:
Practice Address - Street 1:928 RACE ST APT 2A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-2437
Practice Address - Country:US
Practice Address - Phone:215-372-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA32463601OtherDOH LICENSE NUMBER
PA1033513250001Medicaid