Provider Demographics
NPI:1740822527
Name:HILL, CHARIE
Entity type:Individual
Prefix:MISS
First Name:CHARIE
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 WOODHAVEN RD APT 334
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-2930
Mailing Address - Country:US
Mailing Address - Phone:215-571-5570
Mailing Address - Fax:
Practice Address - Street 1:1833 N 33RD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-2541
Practice Address - Country:US
Practice Address - Phone:267-423-6402
Practice Address - Fax:215-893-4768
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-12
Last Update Date:2019-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA43813601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care