Provider Demographics
NPI:1831617570
Name:COMPASSIONATE CARETAKERS HOMECARE AGENCY
Entity type:Organization
Organization Name:COMPASSIONATE CARETAKERS HOMECARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTENA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:215-420-9720
Mailing Address - Street 1:2439 N COLLEGE AVE UNIT 5
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19121-4845
Mailing Address - Country:US
Mailing Address - Phone:215-420-9720
Mailing Address - Fax:
Practice Address - Street 1:2439 N COLLEGE AVE APT 5
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-4845
Practice Address - Country:US
Practice Address - Phone:215-420-9720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA34753601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3475OtherNON SKILLED CARE