Provider Demographics
NPI:1730790700
Name:PA CARE AT HOME SERVICES LLC
Entity type:Organization
Organization Name:PA CARE AT HOME SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VILMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-693-1360
Mailing Address - Street 1:149 W LURAY STREET
Mailing Address - Street 2:1ST FL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-1612
Mailing Address - Country:US
Mailing Address - Phone:267-766-3636
Mailing Address - Fax:267-766-6485
Practice Address - Street 1:149 W LURAY STREET
Practice Address - Street 2:1ST FL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-1612
Practice Address - Country:US
Practice Address - Phone:267-766-3636
Practice Address - Fax:267-766-6485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103800495001Medicaid