39D2283680 CLIA NUMBER - CC HEALTH CARE AGENCY INC

Laboratory Demographics

CLIA Number: 39D2283680

Facility Name: CC HEALTH CARE AGENCY INC

Facility Address:
1102 WEST SOMERVILLE AVE
PHILADELPHIA, PA
ZIP 19141
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Facility Phone Number: 267 304-6775

Facility Type: Home Health Agency

Certificate Type: Waiver

NPI Number: 1396301149

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name	Field Value
CLIA Number	39D2283680
LAB Type	Home Health Agency
Facility Name	CC HEALTH CARE AGENCY INC
Street	1102 WEST SOMERVILLE AVE
City	PHILADELPHIA
State	PA
ZIP	19141
Phone	267 304-6775
CertificateType	4
CertificateEffectiveDate	6/12/2023
CertificateExpirationDate	6/11/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024