Provider Demographics
NPI:1497887749
Name:HOME HEALTH & SUPPORT SERVICES, INC.
Entity type:Organization
Organization Name:HOME HEALTH & SUPPORT SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:570-385-8450
Mailing Address - Street 1:223 ROUTE 61 S
Mailing Address - Street 2:
Mailing Address - City:SCHUYLKILL HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17972-9704
Mailing Address - Country:US
Mailing Address - Phone:570-385-8450
Mailing Address - Fax:570-385-8451
Practice Address - Street 1:223 ROUTE 61 S
Practice Address - Street 2:
Practice Address - City:SCHUYLKILL HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17972-9704
Practice Address - Country:US
Practice Address - Phone:570-385-8450
Practice Address - Fax:570-385-8451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011280690002Medicaid
PA1011280690001Medicaid
PA1011280690005Medicaid