Provider Demographics
NPI:1629063425
Name:PENNSYLVANIA HOME CARE
Entity Type:Organization
Organization Name:PENNSYLVANIA HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT- COMPLIANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:P
Authorized Official - Last Name:ANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-205-2440
Mailing Address - Street 1:620 FREEDOM BUSINESS CTR DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1330
Mailing Address - Country:US
Mailing Address - Phone:610-205-2440
Mailing Address - Fax:610-205-2468
Practice Address - Street 1:620 FREEDOM BUSINESS CTR DR
Practice Address - Street 2:SUITE 105
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1330
Practice Address - Country:US
Practice Address - Phone:610-205-2440
Practice Address - Fax:610-205-2468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007783000OtherFEDERAL BC
PA802384OtherFIRST PRIORITY HMO
PA287470OtherAMERIHEALTH MERCY
PA397190OtherFEDERAL PLAN FEP 104 &105
PAC09743OtherAMERIHEALTH ADMIN
PA2333OtherAETNA
PA397190OtherBC OF NORTHEAST PA
PAB821OtherAMERIHEALTH ADMIN
PA287470OtherAMERIHEALTH MERCY