Provider Demographics
NPI:1194421453
Name:EFORDDASERVICES LLC
Entity type:Organization
Organization Name:EFORDDASERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDRISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HYLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MLS
Authorized Official - Phone:844-753-3673
Mailing Address - Street 1:6523 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19135-2753
Mailing Address - Country:US
Mailing Address - Phone:844-753-3673
Mailing Address - Fax:866-388-1939
Practice Address - Street 1:6523 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-2753
Practice Address - Country:US
Practice Address - Phone:844-753-3673
Practice Address - Fax:866-388-1939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10377019000001Medicaid