Provider Demographics
NPI:1750611323
Name:CREDENCE HOME CARE AGENCY, INC
Entity type:Organization
Organization Name:CREDENCE HOME CARE AGENCY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CAJETAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ONUOHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-764-5529
Mailing Address - Street 1:1415 N BROAD ST STE 118
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19122-3324
Mailing Address - Country:US
Mailing Address - Phone:215-764-5529
Mailing Address - Fax:215-825-8406
Practice Address - Street 1:1415 N BROAD ST STE 118
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19122-3324
Practice Address - Country:US
Practice Address - Phone:215-764-5529
Practice Address - Fax:215-825-8406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA315964261QA0600X
PA31213601374U00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102499867Medicaid