Provider Demographics
NPI:1356636617
Name:RELIANCE FAMILY CARE SERVICES INC.
Entity type:Organization
Organization Name:RELIANCE FAMILY CARE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:G
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:267-519-0672
Mailing Address - Street 1:2146 S BROAD ST
Mailing Address - Street 2:2ND FL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-3905
Mailing Address - Country:US
Mailing Address - Phone:267-519-0672
Mailing Address - Fax:
Practice Address - Street 1:2146 S BROAD ST
Practice Address - Street 2:2ND FL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-3905
Practice Address - Country:US
Practice Address - Phone:267-519-0672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA164W00000X
PA21403601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102549501OtherMPI #
PA164W00000XOtherLPN TAXONOMY
PA21403601OtherDEPARTMENT OF HEALTH