Provider Demographics
NPI:1548844103
Name:SELECTIV CHOICE HOME CARE AGENCY
Entity type:Organization
Organization Name:SELECTIV CHOICE HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AJHAI
Authorized Official - Middle Name:Y
Authorized Official - Last Name:GAMBRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-577-2266
Mailing Address - Street 1:3421 W CHESTER PIKE APT A17
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-4230
Mailing Address - Country:US
Mailing Address - Phone:470-577-2266
Mailing Address - Fax:
Practice Address - Street 1:3421 W CHESTER PIKE APT A17
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-4230
Practice Address - Country:US
Practice Address - Phone:470-577-2266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2278H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedHome HealthGroup - Multi-Specialty