Provider Demographics
NPI:1770097297
Name:CITADEL HOME CARE, LLC
Entity type:Organization
Organization Name:CITADEL HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHESKEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPITZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-232-4641
Mailing Address - Street 1:8601 STENTON AVE
Mailing Address - Street 2:
Mailing Address - City:WYNDMOOR
Mailing Address - State:PA
Mailing Address - Zip Code:19038-8312
Mailing Address - Country:US
Mailing Address - Phone:215-233-6231
Mailing Address - Fax:
Practice Address - Street 1:130 S EASTON RD STE 200
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-4015
Practice Address - Country:US
Practice Address - Phone:215-233-6231
Practice Address - Fax:215-395-6246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-20
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05290501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5290501Medicaid