Organization
PROMINENCE HOME HEALTH CARE AGENCY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FREDDIE L. FAGAN JR. (CHIEF EXECUTIVE OFFICER)
(850) 691-7860
Entity
Organization
Contact information
Practice address
1800 MARKET ST, HARRISBURG, PA 17103-2523
(850) 691-7860
Mailing address
1800 MARKET ST, HARRISBURG, PA 17103-2523
(850) 691-7860
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
48703601
PENNSYLVANIA DEPARTMENT OF HEALTH CERTIFICATE OF LICENSURE
PA
Enumeration date
06/14/2019
Last updated
06/24/2020
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