Provider Demographics
NPI:1316834906
Name:HEALTHCARE LICENSED PERSONNEL, LLC
Entity type:Organization
Organization Name:HEALTHCARE LICENSED PERSONNEL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-200-2214
Mailing Address - Street 1:PO BOX 587
Mailing Address - Street 2:
Mailing Address - City:KOPPEL
Mailing Address - State:PA
Mailing Address - Zip Code:16136-0587
Mailing Address - Country:US
Mailing Address - Phone:724-200-2214
Mailing Address - Fax:724-200-2214
Practice Address - Street 1:406 ARTHUR ST
Practice Address - Street 2:
Practice Address - City:KOPPEL
Practice Address - State:PA
Practice Address - Zip Code:16136-1159
Practice Address - Country:US
Practice Address - Phone:724-200-2214
Practice Address - Fax:724-200-2214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care