Provider Demographics
NPI:1881209088
Name:PA CARE ALLIANCE LLC
Entity Type:Organization
Organization Name:PA CARE ALLIANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BOGDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGTERENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-265-6082
Mailing Address - Street 1:301 HEIGHTS LN APT 40C
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-7650
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 HEIGHTS LN APT 40C
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-7650
Practice Address - Country:US
Practice Address - Phone:267-265-6082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health