1861934978 NPI number — BIG HEART HOME HEALTH CARE LLC

Table of content: KAYLENE SCHOLL HENDERSON MA (NPI 1104342096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861934978 NPI number — BIG HEART HOME HEALTH CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIG HEART HOME HEALTH CARE 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:
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:
1861934978
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4754 BIRCHWOOD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARFIELD HTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44125-2077
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-551-5926
Provider Business Mailing Address Fax Number:
440-815-2237

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4754 BIRCHWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARFIELD HTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44125-2077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-551-5926
Provider Business Practice Location Address Fax Number:
440-815-2237
Provider Enumeration Date:
11/07/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SHELBURN
Authorized Official First Name:
TAMIKA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
216-551-5926

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)





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