Provider Demographics
NPI:1164626461
Name:RELATIVE CARE, LLC
Entity Type:Organization
Organization Name:RELATIVE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:DUNGAN
Authorized Official - Last Name:LAFAZIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-269-2935
Mailing Address - Street 1:36 W LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-2877
Mailing Address - Country:US
Mailing Address - Phone:610-269-2935
Mailing Address - Fax:610-269-9514
Practice Address - Street 1:36 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-2877
Practice Address - Country:US
Practice Address - Phone:610-269-2935
Practice Address - Fax:610-269-9514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 385H00000X
PA372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019433810002Medicaid
PA1019433810001Medicaid
PA1019433810004Medicaid