Provider Demographics
NPI:1275768905
Name:IN HOME PROGRAM
Entity Type:Organization
Organization Name:IN HOME PROGRAM
Other - Org Name:JOURNEYS HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VISCO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:215-232-4357
Mailing Address - Street 1:739 N 24TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2539
Mailing Address - Country:US
Mailing Address - Phone:215-232-4357
Mailing Address - Fax:
Practice Address - Street 1:739 N 24TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-2539
Practice Address - Country:US
Practice Address - Phone:215-232-4357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA397588251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001463956002Medicaid
PA397588Medicare PIN