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.