Healthcare Provider Details

I. General information

NPI: 1104064542
Provider Name (Legal Business Name): CHOICECARE HOMECARE AGNECY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 01/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 BEAUMONT CENTRE CIR
LEXINGTON KY
40513-1954
US

IV. Provider business mailing address

3306 CLAYS MILL RD
LEXINGTON KY
40503-3482
US

V. Phone/Fax

Practice location:
  • Phone: 859-338-9928
  • Fax:
Mailing address:
  • Phone: 849-338-9928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateKY
# 6
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: PEACE JESSA
Title or Position: CEO
Credential:
Phone: 859-338-9928