Organization
123 PEDIATRIC HOME HEALTHCARE CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA JUANITA WASHINGTON RN (CHIEF EXECUTIVE OFFICER)
(412) 377-9102
Entity
Organization
Contact information
Practice address
6309 HALLWOOD DR, VERONA, PA 15147-2526
(412) 377-9102
Mailing address
6309 HALLWOOD DR, VERONA, PA 15147-2526
(412) 377-9102
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
CW017087
PA
163WG0000X
General Practice Registered Nurse
RN620599
PA
163WH0200X
Home Health Registered Nurse
RN620599
PA
163WI0500X
Infusion Therapy Registered Nurse
RN620599
PA
163WP0200X
Pediatric Registered Nurse
RN620599
PA
163WP0218X
Pediatric Oncology Registered Nurse
RN620599
PA
163WW0000X
Wound Care Registered Nurse
RN620599
PA
163WX0200X
Oncology Registered Nurse
RN620599
PA
251B00000X
Case Management Agency
06400501
PA
251E00000X
Home Health Agency
Primary
06400501
PA
251F00000X
Home Infusion Agency
06400501
PA
251J00000X
Nursing Care Agency
06400501
PA
251J00000X
Nursing Care Agency
RN620599
PA
253Z00000X
In Home Supportive Care Agency
30153601
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06400501
STATE OF PENNSYLVANIA
PA
01
—
1030784200001
STATE OF PA DHS OFFICE OF INTELLECTUAL DISABILITIES PROVIDER NUMBER
PA
01
—
1030784200002
STATE OF PA DHS OFFICE OF LONG TERM LIVING PROVIDER NUMBER
PA
01
—
30153601
STATE OF PENNSYLVANIA
PA
Enumeration date
01/05/2016
Last updated
04/18/2018
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