Provider Demographics
NPI:1548225766
Name:VITACARE HOME HEALTH INC
Entity Type:Organization
Organization Name:VITACARE HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLTAVSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-953-9225
Mailing Address - Street 1:255 E STREET RD
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6157
Mailing Address - Country:US
Mailing Address - Phone:215-953-9225
Mailing Address - Fax:215-953-9301
Practice Address - Street 1:255 E STREET RD
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6157
Practice Address - Country:US
Practice Address - Phone:215-953-9225
Practice Address - Fax:215-953-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA77810501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019409770006Medicaid
397781Medicare ID - Type Unspecified