Provider Demographics
NPI:1245721364
Name:CITADEL HOME CARE, LLC
Entity type:Organization
Organization Name:CITADEL HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHESKEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPITZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-232-4641
Mailing Address - Street 1:1000 GATES AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-6296
Mailing Address - Country:US
Mailing Address - Phone:917-805-0702
Mailing Address - Fax:
Practice Address - Street 1:130 S EASTON RD STE 200
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-4015
Practice Address - Country:US
Practice Address - Phone:215-233-6231
Practice Address - Fax:215-395-6246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-24
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA18613601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025984080002Medicaid