Provider Demographics
NPI:1790107936
Name:PHILMONT HOMECARE, LLC
Entity Type:Organization
Organization Name:PHILMONT HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/ ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SLUSARANSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-908-0950
Mailing Address - Street 1:14500 BUSTLETON AVENUE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116
Mailing Address - Country:US
Mailing Address - Phone:267-343-5951
Mailing Address - Fax:267-343-5962
Practice Address - Street 1:14500 BUSTLETON AVENUE
Practice Address - Street 2:SUITE 208
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116
Practice Address - Country:US
Practice Address - Phone:267-343-5951
Practice Address - Fax:267-343-5962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health