Provider Demographics
NPI:1851397012
Name:PENN HOME HEALTH INC.
Entity Type:Organization
Organization Name:PENN HOME HEALTH INC.
Other - Org Name:HERITAGE HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:CARTER
Authorized Official - Last Name:DEYARMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-846-4160
Mailing Address - Street 1:1480 INDIAN SPRINGS RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3249
Mailing Address - Country:US
Mailing Address - Phone:724-465-0440
Mailing Address - Fax:724-465-0444
Practice Address - Street 1:1480 INDIAN SPRINGS RD
Practice Address - Street 2:SUITE 3
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3249
Practice Address - Country:US
Practice Address - Phone:724-465-0440
Practice Address - Fax:724-465-0444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA02360501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0060OtherHIGHMARK BLUE CROSS BLUE
PA1015704300002Medicaid
PA0060OtherHIGHMARK BLUE CROSS BLUE