Immaculate Home Healthcare Agency LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

License

26083601 Issued in PA

Legal business name

IMMACULATE HOME HEALTHCARE AGENCY LLC

Practice address

79 Gridiron Rd
Levittown, PA 19057-3809

Phone

(610) 809-5385

NPI assigned

Oct 30, 2014

Last updated

Jun 23, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Shomari Dekermu Weedor

Title

Owner

Phone

(610) 809-5385

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1414627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592870400000",
    "number": "1942605019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "79 GRIDIRON RD",
            "city": "LEVITTOWN",
            "state": "PA",
            "postal_code": "190573809",
            "telephone_number": "610-809-5385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "79 GRIDIRON RD",
            "city": "LEVITTOWN",
            "state": "PA",
            "postal_code": "190573809",
            "telephone_number": "610-809-5385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMMACULATE HOME HEALTHCARE AGENCY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-30",
        "last_updated": "2020-06-23",
        "certification_date": "2020-06-23",
        "status": "A",
        "authorized_official_last_name": "WEEDOR",
        "authorized_official_first_name": "SHOMARI",
        "authorized_official_middle_name": "DEKERMU",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "610-809-5385",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "PA",
            "license": "26083601",
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "PA",
            "license": "26083601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.