Provider Demographics
NPI:1326447459
Name:HASLAM PROPERTIES
Entity Type:Organization
Organization Name:HASLAM PROPERTIES
Other - Org Name:HOMEWELL OF SOUTHEASTERN PENNSYLVANIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO / PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:HASLAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-938-7375
Mailing Address - Street 1:630 FREEDOM BUSINESS CTR DR
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1331
Mailing Address - Country:US
Mailing Address - Phone:484-938-7375
Mailing Address - Fax:610-768-7755
Practice Address - Street 1:630 FREEDOM BUSINESS CTR DR
Practice Address - Street 2:3RD FLOOR
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1331
Practice Address - Country:US
Practice Address - Phone:484-938-7375
Practice Address - Fax:610-768-7755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA23093601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027597880001OtherMA (MEDICAL ASSISTANCE PROGRAM)