Provider Demographics
NPI:1861007304
Name:EMMANUEL'S PROFESSIONAL SERVICES LLC
Entity Type:Organization
Organization Name:EMMANUEL'S PROFESSIONAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEAUBRUN
Authorized Official - Middle Name:
Authorized Official - Last Name:EMMANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-498-8919
Mailing Address - Street 1:624 LEVICK ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-5738
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6009 TORRESDALE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-3715
Practice Address - Country:US
Practice Address - Phone:267-388-6941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care