Provider Demographics
NPI:1992224109
Name:CHARTER HOME HEALTH STAFFING LLC
Entity Type:Organization
Organization Name:CHARTER HOME HEALTH STAFFING LLC
Other - Org Name:CHARTER HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADEKUNLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABODUNDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-304-7245
Mailing Address - Street 1:123 S BROAD ST
Mailing Address - Street 2:SUITE 2048
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19109
Mailing Address - Country:US
Mailing Address - Phone:267-966-7975
Mailing Address - Fax:267-287-8349
Practice Address - Street 1:123 S BROAD ST STE 2048
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19109-1051
Practice Address - Country:US
Practice Address - Phone:267-966-7975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-19
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103533570-0001Medicaid