Provider Demographics
NPI: | 1487013868 |
---|---|
Name: | ALTRUISTIC HOME HEALTH CARE AGENCY LLC |
Entity Type: | Organization |
Organization Name: | ALTRUISTIC HOME HEALTH CARE AGENCY LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ADMINISTRATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | BERACHAIH |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | EFOGHE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 215-600-0029 |
Mailing Address - Street 1: | 1 NESHAMINY INTERPLEX |
Mailing Address - Street 2: | SUITE 101 |
Mailing Address - City: | TREVOSE |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 19053-6969 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 215-600-0029 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1 NESHAMINY INTERPLEX |
Practice Address - Street 2: | SUITE 101 |
Practice Address - City: | TREVOSE |
Practice Address - State: | PA |
Practice Address - Zip Code: | 19053-6969 |
Practice Address - Country: | US |
Practice Address - Phone: | 215-600-0029 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-02-15 |
Last Update Date: | 2016-09-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | 22753601 | 251E00000X |
PA | 06360501 | 251E00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251E00000X | Agencies | Home Health |