Provider Demographics
NPI:1770022071
Name:A1 HOMECARE, INC.
Entity Type:Organization
Organization Name:A1 HOMECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:KODOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-552-2736
Mailing Address - Street 1:2701 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-1936
Mailing Address - Country:US
Mailing Address - Phone:888-552-2736
Mailing Address - Fax:610-471-0994
Practice Address - Street 1:2701 W 10TH ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-1936
Practice Address - Country:US
Practice Address - Phone:888-552-2736
Practice Address - Fax:610-471-0994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA29223601251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103077460-0001Medicaid