Provider Demographics
NPI:1255662482
Name:IN HOME PROGRAM, INC.
Entity Type:Organization
Organization Name:IN HOME PROGRAM, INC.
Other - Org Name:IN HOME PROGRAM/PREFERRED HOME CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-763-2265
Mailing Address - Street 1:739 N 24TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2539
Mailing Address - Country:US
Mailing Address - Phone:215-763-2265
Mailing Address - Fax:215-763-4146
Practice Address - Street 1:739 N 24TH ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19130-2539
Practice Address - Country:US
Practice Address - Phone:215-763-2265
Practice Address - Fax:215-763-4146
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IN HOME PROGRAM INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA758805164W00000X, 251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014639560002Medicaid
PA758805OtherLICENSE
PA0014639560002Medicaid