Provider Demographics
NPI:1225849227
Name:BRISTOL PIKE HOME CARE. LLC
Entity type:Organization
Organization Name:BRISTOL PIKE HOME CARE. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AGEMEMNON
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-870-6691
Mailing Address - Street 1:3070 BRISTOL PIKE STE 1-206
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-5360
Mailing Address - Country:US
Mailing Address - Phone:856-870-6691
Mailing Address - Fax:
Practice Address - Street 1:3070 BRISTOL PIKE STE 1-206
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-5360
Practice Address - Country:US
Practice Address - Phone:856-870-6691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health