Provider Demographics
NPI:1912158932
Name:IMMEDIATE HOME CARE LLC
Entity type:Organization
Organization Name:IMMEDIATE HOME CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MARI
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-970-1189
Mailing Address - Street 1:3901 MARKET ST STE 5
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3133
Mailing Address - Country:US
Mailing Address - Phone:215-638-2223
Mailing Address - Fax:
Practice Address - Street 1:3901 MARKET ST STE 5
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3133
Practice Address - Country:US
Practice Address - Phone:215-638-2223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IMMEDIATE HOMECARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-08
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA391711Medicare Oscar/Certification