Provider Demographics
NPI:1780039610
Name:COUNTRYWIDE HOME CARE INC
Entity Type:Organization
Organization Name:COUNTRYWIDE HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DMITRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-534-7774
Mailing Address - Street 1:808 N BROAD STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2235
Mailing Address - Country:US
Mailing Address - Phone:800-203-9084
Mailing Address - Fax:215-893-4394
Practice Address - Street 1:808 N BROAD STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-2235
Practice Address - Country:US
Practice Address - Phone:800-203-9084
Practice Address - Fax:215-893-4394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-28
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health