Provider Demographics
NPI:1336501592
Name:DIVINE BREATH HOME CARE CENTER
Entity Type:Organization
Organization Name:DIVINE BREATH HOME CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELET
Authorized Official - Middle Name:
Authorized Official - Last Name:POLECTION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-687-5404
Mailing Address - Street 1:1444 WINDRIM AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHILADLEPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141
Mailing Address - Country:US
Mailing Address - Phone:215-687-5404
Mailing Address - Fax:
Practice Address - Street 1:1444 WINDRIM AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-2238
Practice Address - Country:US
Practice Address - Phone:215-687-5404
Practice Address - Fax:267-331-5660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA29553601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health