Provider Demographics
NPI:1366673790
Name:DEER MEADOWS HOME HEALTH AND SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:DEER MEADOWS HOME HEALTH AND SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOFIA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, AHM, NHA
Authorized Official - Phone:215-624-3333
Mailing Address - Street 1:8301 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2006
Mailing Address - Country:US
Mailing Address - Phone:215-624-6038
Mailing Address - Fax:215-624-6258
Practice Address - Street 1:8301 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2006
Practice Address - Country:US
Practice Address - Phone:215-624-6038
Practice Address - Fax:215-624-6258
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BHP SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251E00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care