Provider Demographics
NPI:1740765585
Name:CITIZENS HOME CARE AGENCY LLC
Entity Type:Organization
Organization Name:CITIZENS HOME CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:ODUWAIYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-200-1520
Mailing Address - Street 1:885 N 66TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-3331
Mailing Address - Country:US
Mailing Address - Phone:215-200-1520
Mailing Address - Fax:
Practice Address - Street 1:885 N 66TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-3331
Practice Address - Country:US
Practice Address - Phone:215-200-1520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health