Provider Demographics
NPI:1639688872
Name:CITIZEN HOME CARE AGENCY LLC
Entity Type:Organization
Organization Name:CITIZEN HOME CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AZARYA
Authorized Official - Middle Name:
Authorized Official - Last Name:YAKUBOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-242-2070
Mailing Address - Street 1:100 SOUTH BROAD STREET
Mailing Address - Street 2:SUITE 815
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19110
Mailing Address - Country:US
Mailing Address - Phone:267-930-7633
Mailing Address - Fax:267-457-3922
Practice Address - Street 1:605 LOUIS DR STE 504
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-2830
Practice Address - Country:US
Practice Address - Phone:267-242-2070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA34703601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health