| Organization Name: | PRIVATE PRACTICE |
| NPI Number: | 1093122954 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KELLY MCCONNELL (RN) |
| Mailing Address: | 202 Fishpot Rd Fredericktown |
| State: | PA US |
| Postal Code: | 153332203 |
| Phone Number: | 7243227745 |
| Fax Number: | |
| NPI Enumeration Date: | 07/11/2014 |
| NPI Last Update Date: | 07/11/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 253Z00000X |
| License Number: | RN320432L |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | In Home Supportive Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |