Provider Demographics
NPI:1417666058
Name:NIRVANA COMPREHENSIVE CARE SERVICES LLC
Entity Type:Organization
Organization Name:NIRVANA COMPREHENSIVE CARE SERVICES LLC
Other - Org Name:HOMEWELL CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-834-9013
Mailing Address - Street 1:1505 N FELTON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-3808
Mailing Address - Country:US
Mailing Address - Phone:215-834-9013
Mailing Address - Fax:
Practice Address - Street 1:1505 N FELTON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-3808
Practice Address - Country:US
Practice Address - Phone:215-834-9013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-22
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA253Z00000XMedicaid