Provider Demographics
NPI:1174169551
Name:ANNIE'S PERSONAL CARE HOME CARE, LLC
Entity type:Organization
Organization Name:ANNIE'S PERSONAL CARE HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMAKO
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-307-7876
Mailing Address - Street 1:261 OLD YORK RD STE 401
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3722
Mailing Address - Country:US
Mailing Address - Phone:215-885-5500
Mailing Address - Fax:215-885-5501
Practice Address - Street 1:261 OLD YORK RD STE 401
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3722
Practice Address - Country:US
Practice Address - Phone:215-885-5500
Practice Address - Fax:215-885-5501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103460043-001Medicaid