Provider Demographics
NPI:1508322447
Name:DUNCAN, KHALIMAH (HOMECARE AGENCY)
Entity Type:Individual
Prefix:
First Name:KHALIMAH
Middle Name:
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:HOMECARE AGENCY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6118 PINE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-1010
Mailing Address - Country:US
Mailing Address - Phone:215-317-5002
Mailing Address - Fax:
Practice Address - Street 1:6118 PINE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-1010
Practice Address - Country:US
Practice Address - Phone:215-317-5002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
39873601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
39873601OtherPA DEPARTMENT OF HEALTH
PA39873601OtherPA DEPARTMENT OF HEALTH