Organization
IMMACULATE HOME HEALTHCARE AGENCY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHOMARI DEKERMU WEEDOR (OWNER)
(610) 809-5385
Entity
Organization
Contact information
Practice address
79 GRIDIRON RD, LEVITTOWN, PA 19057-3809
(610) 809-5385
Mailing address
79 GRIDIRON RD, LEVITTOWN, PA 19057-3809
(610) 809-5385
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
26083601
PA
253Z00000X
In Home Supportive Care Agency
Primary
26083601
PA
Other
Enumeration date
10/30/2014
Last updated
06/23/2020
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