Provider Demographics
NPI:1992779557
Name:RIDGAWAY PHILLIPS HOME CARE SERVICES
Entity type:Organization
Organization Name:RIDGAWAY PHILLIPS HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQULINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-643-1200
Mailing Address - Street 1:909 SUMNEYTOWN PIKE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SPRING HOUSE
Mailing Address - State:PA
Mailing Address - Zip Code:19477-1011
Mailing Address - Country:US
Mailing Address - Phone:215-643-1200
Mailing Address - Fax:215-540-0756
Practice Address - Street 1:909 SUMNEYTOWN PIKE
Practice Address - Street 2:SUITE 105
Practice Address - City:SPRING HOUSE
Practice Address - State:PA
Practice Address - Zip Code:19477-1011
Practice Address - Country:US
Practice Address - Phone:215-643-1200
Practice Address - Fax:215-540-0756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA719705251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA397197AMedicare Oscar/Certification