Provider Demographics
NPI:1487302923
Name:STAYLIVINGWELL HOMECARE
Entity type:Organization
Organization Name:STAYLIVINGWELL HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-252-6369
Mailing Address - Street 1:610 OLD YORK ROAD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046
Mailing Address - Country:US
Mailing Address - Phone:215-866-7112
Mailing Address - Fax:
Practice Address - Street 1:610 OLD YORK ROAD
Practice Address - Street 2:SUITE 400
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046
Practice Address - Country:US
Practice Address - Phone:215-866-7112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:-
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103889259-0001Medicaid