Individual
JAKE L KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5350 GAINOR RD, PHILADELPHIA, PA 19131-2338
(610) 605-0558
Mailing address
4012 RENO ST, PHILADELPHIA, PA 19104-4827
(610) 605-0558
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
04/27/2026
Last updated
04/27/2026
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