Provider Demographics
NPI:1528712171
Name:PURE AGE HOME CARE AGENCY LLC
Entity type:Organization
Organization Name:PURE AGE HOME CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAGHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-882-8269
Mailing Address - Street 1:1611 PEACH ST STE 405
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-2123
Mailing Address - Country:US
Mailing Address - Phone:814-882-8269
Mailing Address - Fax:
Practice Address - Street 1:1611 PEACH ST STE 405
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-2123
Practice Address - Country:US
Practice Address - Phone:814-882-8269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care