Healthcare Provider Details

I. General information

NPI: 1871863365
Provider Name (Legal Business Name): HOZZY'S HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2011
Last Update Date: 12/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S HANOVER ST
METAMORA IL
61548-9779
US

IV. Provider business mailing address

222 S HANOVER ST
METAMORA IL
61548-9779
US

V. Phone/Fax

Practice location:
  • Phone: 309-360-3181
  • Fax:
Mailing address:
  • Phone: 309-360-3181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateIL

VIII. Authorized Official

Name: MRS. RAYE L HOSBROUGH
Title or Position: OWNER
Credential: CNA
Phone: 309-360-3181