Provider Demographics
NPI:1518633320
Name:POTENTIAL CARE LLC
Entity Type:Organization
Organization Name:POTENTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELVINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-800-0103
Mailing Address - Street 1:5137 SPRUCE ST
Mailing Address - Street 2:FL 1R
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139
Mailing Address - Country:US
Mailing Address - Phone:610-800-0103
Mailing Address - Fax:
Practice Address - Street 1:5137 SPRUCE ST
Practice Address - Street 2:FL 1R
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139
Practice Address - Country:US
Practice Address - Phone:610-800-0103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care