Successful Aging Care Net Inc

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

80200501 Issued in PA

Legal business name

SUCCESSFUL AGING CARE NET INC

Practice address

48 Garrett Rd
Upper Darby, PA 19082-2303

Phone

(484) 461-8711

Fax

(610) 284-4170

NPI assigned

Nov 16, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Innocent Onwubiko, MSHA, MSGS

Title

Owner

Phone

(484) 461-8711

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Home health agency certification: CCN 398020

Legal name

SUCCESSFUL AGING CARE NET INC

Doing business as

SUCCESSFUL AGING CARE NET INC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Mar 22, 2012

Last certification

Jan 27, 2021

Ownership / control type

Proprietary

Organization structure

CorporationProprietary

Incorporated

Jun 1, 2004 in PA

Enrollment address

38 Garrett Rd
Upper Darby, PA 19082-2303

Listed as

Successful Aging IncCCN 398020

Ownership

Proprietary

Certified

Mar 22, 2012

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Home health aide

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306368000000",
    "number": "1790767622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "48 GARRETT RD",
            "city": "UPPER DARBY",
            "state": "PA",
            "postal_code": "190822303",
            "telephone_number": "484-461-8711",
            "fax_number": "610-284-4170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48 GARRETT RD",
            "city": "UPPER DARBY",
            "state": "PA",
            "postal_code": "190822303",
            "telephone_number": "484-461-8711",
            "fax_number": "610-284-4170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUCCESSFUL AGING CARE NET INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-16",
        "last_updated": "2011-05-26",
        "status": "A",
        "authorized_official_last_name": "ONWUBIKO",
        "authorized_official_first_name": "INNOCENT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "484-461-8711",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSHA, MSGS"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "PA",
            "license": "80200501",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "PA",
            "license": "5418770001",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1011366320001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1011366320002",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOME HEALTHCARE LICENSE",
            "identifier": "80200501",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.