Provider Demographics
NPI:1871134007
Name:JENKINS, ERIN (MBA, MS)
Entity type:Individual
Prefix:MR
First Name:ERIN
Middle Name:
Last Name:JENKINS
Suffix:
Gender:M
Credentials:MBA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2746 WELSH RD
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-1525
Mailing Address - Country:US
Mailing Address - Phone:267-456-0024
Mailing Address - Fax:
Practice Address - Street 1:2746 WELSH RD
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19152-1525
Practice Address - Country:US
Practice Address - Phone:267-456-0024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-29
Last Update Date:2019-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA44463601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA44463601Medicaid