Organization
1ST INDEPENDENCE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JADAN MONAE RANDOLPH (OWNER)
(856) 813-6379
Entity
Organization
Contact information
Practice address
3314 N BOUVIER ST, PHILADELPHIA, PA 19140-4921
(215) 278-9237
Mailing address
3314 N BOUVIER ST, PHILADELPHIA, PA 19140-4921
(215) 278-9237
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
10/26/2020
Last updated
07/07/2021
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