Provider Demographics
NPI:1346714813
Name:PUBLIC CHOICE HOMECARE LLC
Entity Type:Organization
Organization Name:PUBLIC CHOICE HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEATHAM
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:215-907-7003
Mailing Address - Street 1:1708 MOHICAN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19138-1116
Mailing Address - Country:US
Mailing Address - Phone:215-907-7003
Mailing Address - Fax:
Practice Address - Street 1:9202 OLD NEWTOWN RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-4908
Practice Address - Country:US
Practice Address - Phone:215-907-7003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-17
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30905303Medicaid