Provider Demographics
NPI:1043810583
Name:GREATER LOVE HOME HEALTH CARE, INC
Entity type:Organization
Organization Name:GREATER LOVE HOME HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AUGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-433-8208
Mailing Address - Street 1:8600 W CHESTER PIKE STE 300
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-2629
Mailing Address - Country:US
Mailing Address - Phone:484-479-7888
Mailing Address - Fax:
Practice Address - Street 1:8600 W CHESTER PIKE STE 300
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-2629
Practice Address - Country:US
Practice Address - Phone:484-479-7888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREATER LOVE HOME HEALTH CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA07370501Medicaid