Provider Demographics
NPI:1710129762
Name:WILKES BARRE HOME CARE SERVICES LLC
Entity type:Organization
Organization Name:WILKES BARRE HOME CARE SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PROFFITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-223-1307
Mailing Address - Street 1:PO BOX 51266
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-1266
Mailing Address - Country:US
Mailing Address - Phone:337-223-1307
Mailing Address - Fax:337-443-4154
Practice Address - Street 1:900 RUTTER AVENUE
Practice Address - Street 2:SUITE 8
Practice Address - City:FORTY FORT
Practice Address - State:PA
Practice Address - Zip Code:18704-4962
Practice Address - Country:US
Practice Address - Phone:570-718-4400
Practice Address - Fax:570-718-4823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024334440003Medicaid