Provider Demographics
NPI:1699407981
Name:IMMENSE PROVIDERS HOME CARE LLC
Entity Type:Organization
Organization Name:IMMENSE PROVIDERS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAKEERAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-259-3957
Mailing Address - Street 1:1 INTERNATIONAL PLZ STE 550
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19113-1528
Mailing Address - Country:US
Mailing Address - Phone:215-617-3839
Mailing Address - Fax:
Practice Address - Street 1:1 INTERNATIONAL PLZ STE 550
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19113-1528
Practice Address - Country:US
Practice Address - Phone:672-593-9572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health