Provider Demographics
NPI:1164920104
Name:PENNSTATE HOME CARE SERVICES
Entity Type:Organization
Organization Name:PENNSTATE HOME CARE SERVICES
Other - Org Name:PENNSTATE HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HUSSEIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-297-7265
Mailing Address - Street 1:5223 GERMANTOWN AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-2301
Mailing Address - Country:US
Mailing Address - Phone:267-399-0314
Mailing Address - Fax:
Practice Address - Street 1:5223 GERMANTOWN AVE STE 103
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-2301
Practice Address - Country:US
Practice Address - Phone:267-399-0314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103374123-0001OtherWAIVER PROVIDER