Provider Demographics
NPI:1548577190
Name:PAULA SAM
Entity type:Organization
Organization Name:PAULA SAM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAM
Authorized Official - Suffix:
Authorized Official - Credentials:MS GERONTOLOGY, BA
Authorized Official - Phone:215-544-1173
Mailing Address - Street 1:5344 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-3335
Mailing Address - Country:US
Mailing Address - Phone:215-544-1173
Mailing Address - Fax:215-544-1173
Practice Address - Street 1:5344 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-3335
Practice Address - Country:US
Practice Address - Phone:215-544-1173
Practice Address - Fax:215-544-1173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health