Provider Demographics
NPI:1053745802
Name:MY INDEPENDENCE AT HOME, LLC
Entity type:Organization
Organization Name:MY INDEPENDENCE AT HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WINFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-480-0826
Mailing Address - Street 1:5398 WYNNEFIELD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-2344
Mailing Address - Country:US
Mailing Address - Phone:215-921-2277
Mailing Address - Fax:
Practice Address - Street 1:5398 WYNNEFIELD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-2344
Practice Address - Country:US
Practice Address - Phone:215-921-2277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care