Provider Demographics
NPI:1174841050
Name:RELIABLE CAREGIVERS
Entity Type:Organization
Organization Name:RELIABLE CAREGIVERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:STUPPARD
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:215-624-1321
Mailing Address - Street 1:2924 BRIGHTON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-1922
Mailing Address - Country:US
Mailing Address - Phone:215-624-1321
Mailing Address - Fax:215-624-1034
Practice Address - Street 1:2924 BRIGHTON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1922
Practice Address - Country:US
Practice Address - Phone:215-624-1321
Practice Address - Fax:215-624-1034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA16713601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health