Provider Demographics
NPI:1699046821
Name:CISCO HOMECARE AGENCY
Entity type:Organization
Organization Name:CISCO HOMECARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARTHURLINE
Authorized Official - Middle Name:TUCKER
Authorized Official - Last Name:CISCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-385-1512
Mailing Address - Street 1:435 BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-3714
Mailing Address - Country:US
Mailing Address - Phone:267-385-1512
Mailing Address - Fax:
Practice Address - Street 1:435 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-3714
Practice Address - Country:US
Practice Address - Phone:267-385-1512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health