Healthcare Provider Details

I. General information

NPI: 1114923257
Provider Name (Legal Business Name): CORNER HOMECARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CASSIDY AVE
FREDONIA KY
42411-9207
US

IV. Provider business mailing address

108 E WASHINGTON ST
PRINCETON KY
42445-2250
US

V. Phone/Fax

Practice location:
  • Phone: 270-545-3413
  • Fax: 270-545-3427
Mailing address:
  • Phone: 270-365-3903
  • Fax: 270-365-2024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number StateKY
# 6
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateKY

VIII. Authorized Official

Name: MR. STEVEN K PPOOL
Title or Position: PRESIDENT
Credential:
Phone: 270-365-3903