1114483500 NPI number — NO PLACE LIKE HOME, LLC

Table of content: (NPI 1114483500)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114483500 NPI number — NO PLACE LIKE HOME, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NO PLACE LIKE HOME, LLC
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:
NO PLACE LIKE HOME, HOME HEALTH
Provider Other Organization Name Type Code:
3
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:
1114483500
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1305 MADILL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEYSTONE
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57751-2075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-666-4149
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1305 MADILL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEYSTONE
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57751-2075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-666-4149
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/11/2019

Additional Information

Authorized Official

Authorized Official Last Name:
GENNARO
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
402-680-3889

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 347C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1164987764 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9551220 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




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