Provider Demographics
NPI:1609227313
Name:ST LUKES PETALS HOME CARE
Entity Type:Organization
Organization Name:ST LUKES PETALS HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXCUTIVE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:NELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KABIRU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-347-8100
Mailing Address - Street 1:2 MARYLAND CIR APT 324
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-6352
Mailing Address - Country:US
Mailing Address - Phone:610-340-0540
Mailing Address - Fax:
Practice Address - Street 1:2 MARYLAND CIR APT 324
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-6352
Practice Address - Country:US
Practice Address - Phone:610-340-0540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6419944253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care