Provider Demographics
NPI:1720732746
Name:HAROLD, DE'JA QUAHIRA
Entity Type:Individual
Prefix:
First Name:DE'JA
Middle Name:QUAHIRA
Last Name:HAROLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 STENTON AVE APT 7J
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-3229
Mailing Address - Country:US
Mailing Address - Phone:267-235-1246
Mailing Address - Fax:
Practice Address - Street 1:1917 E BIRCH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-3517
Practice Address - Country:US
Practice Address - Phone:267-235-1246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No385H00000XRespite Care FacilityRespite Care