Provider Demographics
NPI:1366929903
Name:HUMANE HOME CARE AGENCY
Entity type:Organization
Organization Name:HUMANE HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:TAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-321-9939
Mailing Address - Street 1:3040 WILLITS RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-1115
Mailing Address - Country:US
Mailing Address - Phone:267-321-9939
Mailing Address - Fax:215-203-1966
Practice Address - Street 1:3235 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134
Practice Address - Country:US
Practice Address - Phone:267-321-9939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103114278-0001Medicaid