1013129998 NPI number — JEFFERSON COUNTY HOMEMAKER-HOME HEALTH AIDE SERVICE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013129998 NPI number — JEFFERSON COUNTY HOMEMAKER-HOME HEALTH AIDE SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFERSON COUNTY HOMEMAKER-HOME HEALTH AIDE SERVICE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013129998
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 W BRIGGS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52556-2826
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-472-5929
Provider Business Mailing Address Fax Number:
641-469-3189

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 W BRIGGS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52556-2826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-472-5929
Provider Business Practice Location Address Fax Number:
641-469-3189
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCKEEVER
Authorized Official First Name:
VICTORIA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
641-472-5929

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0149492 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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