PERSONAL CARE HOME C&G INC NPI 1003356452

NPI Information

NPI: 1003356452
Provider Name: PERSONAL CARE HOME C&G, INC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

Address:
4104 N 5TH ST
PHILADELPHIA, PA
ZIP 19140
Phone: (215) 223-0200
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PERSONAL CARE HOME C&G, INC is a primary care clinic center in Philadelphia, PA. PERSONAL CARE HOME C&G, INC NPI is 1003356452. The provider is registered as an organization entity type.

The provider's business location address is:

4104 N 5TH ST
PHILADELPHIA, PA
ZIP 19140-614
Phone: (215) 223-0200

The provider's authorized official is Samuel Quartey .
The authorized official title is Medical Director and has the following contact phone number (215) 471-1407.

The enumeration date for this NPI number is 3/5/2017 and was last updated on 3/3/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	251E00000X	Home Health		No
2	261Q00000X	Clinic/Center		No
3	311ZA0620X	Custodial Care Facility	Adult Care Home	No
4	261QP2300X	Clinic/Center	Primary Care	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1038419160001	MEDICAID	PENNSYLVANIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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