Provider Demographics
NPI:1922644145
Name:PRUDENTIACARE HOME HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:PRUDENTIACARE HOME HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CE0
Authorized Official - Prefix:
Authorized Official - First Name:SHAVON
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-978-5109
Mailing Address - Street 1:1 INTERNATIONAL PLZ # 517
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19113-1510
Mailing Address - Country:US
Mailing Address - Phone:888-978-5109
Mailing Address - Fax:888-978-5109
Practice Address - Street 1:1 INTERNATIONAL PLZ # 517
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19113-1510
Practice Address - Country:US
Practice Address - Phone:888-978-5109
Practice Address - Fax:888-978-5109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)