DEDICATED PENNSYLVANIA HOLDING, LLC (NPI# 1477053569) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477053569 |
| Entity Type | Organization |
| Organization Name | DEDICATED PENNSYLVANIA HOLDING, LLC |
| Other Organization Name | DEDICATED PENNSYLVANIA MAYFAIR |
| Practice Address |
6431 Sackett St Philadelphia PA 19149-3118 |
| Mailing Address |
1395 N.w/ 167th Street Payer Enrollment Department Miami Gardens FL 33169 |
| Practice Telephone | 3056286117 |
| Practice Fax Number | 3053635989 |
| Mailing Telephone | 7868704039 |
| Mailing Fax Number | 7868704039 |
| Enumeration Date | 2018-02-15 |
| Last Update Date | 2018-03-27 |
| Authorized Official Name | MR. RAYMOND JIMENEZ (DIRECTOR OF CLIENT SERVICES) |
| Authorized Official Telephone | 7868704039 |
| Is Organization Subpart | Y |
| Parent Organization Name | DEDICATED PENNSYLVANIA MAYFAIR |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities | ||
| N | 332900000X | Non-Pharmacy Dispensing Site | Suppliers | ||
| Y | 174400000X | Specialist | Other Service Providers |
| Other Name | Type Code |
|---|---|
| Dedicated Pennsylvania Mayfair | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023655602 | Dedicated Pennsylvania Holding, LLC | Non-Pharmacy Dispensing Site | 330 W Oregon Ave # 170, Philadelphia, PA 19148-4723 | 2019-12-03 |
| 1366950776 | Dedicated Pennsylvania Holding, LLC | Clinic/Center | 5675 N. Front Strreet, Suite 141, Philadelphia, PA 19120-1910 | 2018-01-19 |
| 1942703137 | Dedicated Pennsylvania Holding, LLC | Specialist | 1575 N 52nd St Ste S-3, Philadelphia, PA 19131-4736 | 2018-03-14 |
| 1952804312 | Dedicated Pennsylvania Holding, LLC | Specialist | 2101 W Lehigh Ave Ste A, Philadelphia, PA 19132-2664 | 2018-03-13 |
| 1841707965 | Dedicated Pennsylvania Holding, LLC | Family Medicine | 5675 N Front St Ste 141, Philadelphia, PA 19120-2719 | 2018-01-10 |
| Street Address |
6431 SACKETT ST |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19149-3118 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720183254 | Susan Schayes | Family Medicine | 6431 Sackett St, Philadelphia, PA 19149-3118 | 2006-09-13 |
| 1609226752 | Monica Joy Lobue | Family Medicine | 6431 Sackett St, Philadelphia, PA 19149-3118 | 2016-06-20 |
| 1447647516 | Victoria Cimino | Internal Medicine | 6431 Sackett St, Philadelphia, PA 19149-3118 | 2015-04-16 |
| 1023351921 | Peter Rajacic | Internal Medicine | 6431 Sackett St, Philadelphia, PA 19149-3118 | 2013-03-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508418948 | Double Care Inc | Clinic/Center | 2900-14 Cottman Ave, Philadelphia, PA 19149 | 2019-07-16 |
| 1710539457 | Xiao Rong Li | Adult Companion | 2900 - 14 Cottman Avenue, Philadelphia, PA 19149 | 2019-07-12 |
| 1154982775 | K Dental LLC | Clinic/Center | 6214 Bustleton Avenue, Philadelphia, PA 19149 | 2019-06-25 |
| 1851950430 | Halo Staffing Agency, LLC | Home Health | 6401 Akron St., Philadelphia, PA 19149 | 2019-06-07 |
| 1518450626 | Family First Home Healthcare LLC | In Home Supportive Care | 1405 Alcott St, Philadelphia, PA 19149 | 2018-06-13 |
| 1992106926 | Elena Semprevivo | Dentist | 2107 Cottman Avenue, Philadelphia, PA 19149 | 2014-09-09 |
| 1518366988 | Abundant Life Home Health Services | Home Health | 6632-46 Bustleton Ave, Philadelphia, PA 19149 | 2014-08-21 |
| 1598189771 | Citywide Community Counseling Services | Clinic/Center | 1346 Knorr St, Philadelphia, PA 19149 | 2014-02-10 |
| 1114341328 | Citywide Community Counseling Services | Clinic/Center | 5807 Bustleton Avenue, Philadelphia, PA 19149 | 2014-02-07 |
| 1790115509 | Norman Huynh | Physical Therapist | 6595 B East Roosevelt Boulevard, Philadelphia, PA 19149 | 2013-11-14 |
| Find all providers in zip 19149 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174156012 | Sade Yolanda Davis | Specialist | 2414 N Garnet St, Philadelphia, PA 19132-3725 | 2020-02-19 |
| 1356803993 | Larkerra Goodson | Specialist | 1336 Arrott St Apt E15, Philadelphia, PA 19124-3281 | 2019-04-03 |
| 1306302617 | Keisha Robinson | Specialist | 6852 Regent St, Philadelphia, PA 19142-1213 | 2019-02-12 |
| 1740758168 | William Whitaker | Specialist | 1115 E Sanger St, Philadelphia, PA 19124-1130 | 2018-11-02 |
| 1902395536 | Ran Barzilay | Specialist | 3440 Market St, Suite 200, Philadelphia, PA 19104 | 2018-05-09 |
| 1093229668 | Danielle M Marshall | Specialist | 514 Seville St Apt 7, Philadelphia, PA 19128-2737 | 2017-11-19 |
| 1336651017 | Radhia Afif | Specialist | 5943 Weymouth St, Philadelphia, PA 19120-1122 | 2017-11-02 |
| 1306383401 | Helping Hair LLC | Specialist | 930 N 50th St, Philadelphia, PA 19131-5102 | 2017-01-26 |
| 1447796172 | Kristen Halvorson | Specialist | 3411 Cresson St, Apartment 6, Philadelphia, PA 19129-1654 | 2017-01-19 |
| 1174079131 | Sadia Randolph | Specialist | 6718 Paschall Ave, Philadelphia, PA 19142-1809 | 2016-08-30 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19149 |
Please comment or provide details below to improve the information on DEDICATED PENNSYLVANIA HOLDING, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.