Provider Demographics
NPI:1255942082
Name:PROMINENT HOMECARE AGENCY LLC
Entity type:Organization
Organization Name:PROMINENT HOMECARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-678-8208
Mailing Address - Street 1:258 PENNWOOD ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2207
Mailing Address - Country:US
Mailing Address - Phone:267-678-8208
Mailing Address - Fax:
Practice Address - Street 1:1319 EDGEHILL RD
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1325
Practice Address - Country:US
Practice Address - Phone:267-678-8208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care