Provider Demographics
NPI:1538549787
Name:HUNTINGDON VALLEY HOMECARE LLC
Entity type:Organization
Organization Name:HUNTINGDON VALLEY HOMECARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:267-279-9113
Mailing Address - Street 1:995 JAYMOR RD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3855
Mailing Address - Country:US
Mailing Address - Phone:267-279-9113
Mailing Address - Fax:
Practice Address - Street 1:995 JAYMOR RD
Practice Address - Street 2:SUITE #2
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3855
Practice Address - Country:US
Practice Address - Phone:267-279-9113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA004121396OtherINDEPENDENCE
PA1031961930002Medicaid