Provider Demographics
NPI:1770028177
Name:MEDI-HOME HEALTHCARE AGENCY
Entity Type:Organization
Organization Name:MEDI-HOME HEALTHCARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RILMA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCOTT-LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:267-761-1630
Mailing Address - Street 1:5716 N CAMAC ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-4108
Mailing Address - Country:US
Mailing Address - Phone:267-761-1630
Mailing Address - Fax:267-217-1060
Practice Address - Street 1:5716 N CAMAC ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-4108
Practice Address - Country:US
Practice Address - Phone:267-761-1630
Practice Address - Fax:267-217-1060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA32083601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3208Medicare PIN