Provider Demographics
NPI:1164778338
Name:DIRECT HOME CARE INC.
Entity Type:Organization
Organization Name:DIRECT HOME CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-312-6858
Mailing Address - Street 1:6511 VINE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-1038
Mailing Address - Country:US
Mailing Address - Phone:267-312-6858
Mailing Address - Fax:
Practice Address - Street 1:6511 VINE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-1038
Practice Address - Country:US
Practice Address - Phone:267-312-6858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA22883601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA251E00000XOtherHOME HEALTH
PA251E00000XOtherHOME HEALTH CARE
PA253Z00000XOtherIN HOME SUPPORTIVE CARE