Organization
PERSONAL CARE HOME C&G, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL QUARTEY PDM (MEDICAL DIRECTOR)
(215) 471-1407
Entity
Organization
Contact information
Practice address
4104 N 5TH ST, PHILADELPHIA, PA 19140-2614
(215) 223-0200
Mailing address
6176 NEWTOWN AVE, PHILADELPHIA, PA 19111-5928
(267) 978-3040
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
261Q00000X
Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
311ZA0620X
Adult Care Home Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1038419160001
—
PA
Enumeration date
03/05/2017
Last updated
03/03/2022
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