Provider Demographics
NPI:1295074045
Name:PREFERRED GERIATRIC HEALTH CARE,LLC
Entity type:Organization
Organization Name:PREFERRED GERIATRIC HEALTH CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ORISHA
Authorized Official - Last Name:BOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-551-5620
Mailing Address - Street 1:272 S 56TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-3903
Mailing Address - Country:US
Mailing Address - Phone:215-551-5620
Mailing Address - Fax:215-474-4850
Practice Address - Street 1:272 S 56TH ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19139-3903
Practice Address - Country:US
Practice Address - Phone:215-551-5620
Practice Address - Fax:215-474-4850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-13
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA23573601251K00000X, 251V00000X, 322D00000X, 320600000X, 3245S0500X, 3104A0625X, 311ZA0620X, 310500000X, 385HR2055X, 385HR2060X, 385HR2065X, 253J00000X, 251B00000X, 251S00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or Welfare
No251V00000XAgenciesVoluntary or Charitable
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
No253J00000XAgenciesFoster Care Agency
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health