Provider Demographics
NPI:1902176787
Name:SCRANTON QUINCY HOME CARE SERVICES
Entity Type:Organization
Organization Name:SCRANTON QUINCY HOME CARE SERVICES
Other - Org Name:COMMONWEALTH HOME HEALTH OF MOSES TAYLOR
Other - Org Type:Doing Business As
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:337-233-1307
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 1:3 W OLIVE ST STE 206
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-2574
Practice Address - Country:US
Practice Address - Phone:570-800-5557
Practice Address - Fax:570-800-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027966920002Medicaid
PA1467434761OtherOLD NPI
PA240795461OtherOLD EIN