1205855640 NPI number — IN HOME CARE

Table of content: (NPI 1205855640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205855640 NPI number — IN HOME CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IN HOME CARE
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:
1205855640
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 NOTTINGHAM AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WISE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24293-5612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 NOTTINGHAM AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WISE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24293-5612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-329-9340
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WHITAKER
Authorized Official First Name:
YVONNE
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY CORP
Authorized Official Telephone Number:
276-329-9340

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4971051 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8751234 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9600019 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9600167 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8702101 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010015324 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8702861 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8740399 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8771758 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8701768 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8742049 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8743541 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8743584 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8771987 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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