Provider Demographics
NPI:1285258335
Name:J30 HOME HEALTH CARE
Entity type:Organization
Organization Name:J30 HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMAL-KALEE
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:LBS
Authorized Official - Phone:267-767-0662
Mailing Address - Street 1:272 MACDONALD AVE
Mailing Address - Street 2:
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095-2402
Mailing Address - Country:US
Mailing Address - Phone:267-767-0662
Mailing Address - Fax:
Practice Address - Street 1:272 MACDONALD AVE
Practice Address - Street 2:
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095-2402
Practice Address - Country:US
Practice Address - Phone:267-767-0662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-04
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health