1861867616 NPI number — A & P QUALITY HOME CARE AGENCY, LLC

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 1861867616 NPI number — A & P QUALITY HOME CARE AGENCY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A & P QUALITY HOME CARE AGENCY, 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:
1861867616
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
37 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAGERSTOWN
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47346-1212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-530-8011
Provider Business Mailing Address Fax Number:
765-530-8143

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAGERSTOWN
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47346-1212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-744-7139
Provider Business Practice Location Address Fax Number:
765-530-8011
Provider Enumeration Date:
12/04/2015

Additional Information

Authorized Official

Authorized Official Last Name:
ADDISON
Authorized Official First Name:
DARYL
Authorized Official Middle Name:
GENE
Authorized Official Title or Position:
CO-FOUNDER
Authorized Official Telephone Number:
765-530-8011

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  15-013768-1 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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