Provider Demographics
NPI:1114766490
Name:ADULT GERO PRIME HC SERVICES
Entity type:Organization
Organization Name:ADULT GERO PRIME HC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADUNNI
Authorized Official - Middle Name:MUDIWA
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:973-220-5984
Mailing Address - Street 1:240 N WYCOMBE AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-1618
Mailing Address - Country:US
Mailing Address - Phone:973-220-5984
Mailing Address - Fax:215-664-5565
Practice Address - Street 1:240 N WYCOMBE AVE
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-1618
Practice Address - Country:US
Practice Address - Phone:973-220-5984
Practice Address - Fax:215-664-5565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1477217180Medicaid