Provider Demographics
NPI:1669042719
Name:MODACARE HOME CARE AGENCY LLC
Entity Type:Organization
Organization Name:MODACARE HOME CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:BREFO
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-974-0771
Mailing Address - Street 1:9200 BUSTLETON AVE APT 906
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-4223
Mailing Address - Country:US
Mailing Address - Phone:267-974-0771
Mailing Address - Fax:
Practice Address - Street 1:9200 BUSTLETON AVE APT 906
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-4223
Practice Address - Country:US
Practice Address - Phone:267-974-0771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care