IMMACULATE MARY HOME NPI 1780751115

NPI Information

NPI: 1780751115
Provider Name: IMMACULATE MARY HOME
Classification: Durable Medical Equipment & Medical Supplies - 332BP3500X
Specialization: Parenteral & Enteral Nutrition
Entity Type: Organization
CLIA Number: 39D0202602
Address: 2990 HOLME AVE
PHILADELPHIA, PA
ZIP 19136
Phone: (215) 335-2100

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NPI Details

IMMACULATE MARY HOME is a parenteral and enteral nutrition durable medical equipment medical supplies in Philadelphia, PA. IMMACULATE MARY HOME NPI is 1780751115. The provider is registered as an organization entity type.

The provider's business location address is:

2990 HOLME AVE
PHILADELPHIA, PA
ZIP 19136-830
Phone: (215) 335-2100
Fax: (215) 368-5254

The provider's authorized official is Michael Czekner .
The authorized official title is Chief Financial Officer and has the following contact phone number (215) 368-0900.

The CLIA number assigned to this NPI record is 39D0202602 - skilled nursing facility/nursing facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/29/2006 and was last updated on 8/22/2020.

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	License Number	License State	Primary
1	332BP3500X	Durable Medical Equipment & Medical Supplies	Parenteral & Enteral Nutrition	090902	PENNSYLVANIA	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	0649990001	OTHER		NSC DME SUPPLIER NO

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: 11/21/2025

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