Healthcare Provider Details

I. General information

NPI: 1902453459
Provider Name (Legal Business Name): BRANCHING OFF, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N HERSHEY RD STE B
BLOOMINGTON IL
61704-7720
US

IV. Provider business mailing address

303 N HERSHEY RD STE B
BLOOMINGTON IL
61704-7720
US

V. Phone/Fax

Practice location:
  • Phone: 309-808-4409
  • Fax:
Mailing address:
  • Phone: 309-808-4409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: BEKIME FEEZOR-BRANCH
Title or Position: ADMINISTRATOR/OWNER
Credential:
Phone: 309-750-0558