Provider Demographics
NPI:1760019871
Name:TRI-STATE HOME CARE SERVICES OF PENNSYLVANIA, LLC
Entity Type:Organization
Organization Name:TRI-STATE HOME CARE SERVICES OF PENNSYLVANIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:855-813-1332
Mailing Address - Street 1:127 PRESIDENTS ST.
Mailing Address - Street 2:
Mailing Address - City:FORT ASHBY
Mailing Address - State:WV
Mailing Address - Zip Code:26719-0017
Mailing Address - Country:US
Mailing Address - Phone:855-813-1332
Mailing Address - Fax:304-298-3435
Practice Address - Street 1:1150 FIRST AVE STE 511
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1316
Practice Address - Country:US
Practice Address - Phone:855-813-1332
Practice Address - Fax:304-298-3435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-26
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty