Organization · NPI-2

1st Independence LLC

In Home Supportive Care · Philadelphia, PA

NPI number1083213573
StatusActive
Last updated in NPPESJul 7, 2021

Details

NPI
1083213573
Entity type
Organization (NPI-2)
Legal business name
1st Independence LLC
Organization subpart
No
Enumeration date
Oct 26, 2020
Certification date
Jul 7, 2021
Last updated
Jul 7, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
253Z00000X In Home Supportive Care––Yes
251E00000X Home Health––

Practice location

3314 N Bouvier St
Philadelphia, PA 19140-4921

Phone 215-278-9237

Mailing address

3314 N Bouvier St
Philadelphia, PA 19140-4921

Phone 215-278-9237

Authorized official

Jadan Monae Randolph
Owner
8568136379

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