Healthcare Provider Details

I. General information

NPI: 1033966106
Provider Name (Legal Business Name): PCAH HOMETOWN CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W VINE ST STE 300
LEXINGTON KY
40507-1872
US

IV. Provider business mailing address

4112 GUINN RD
KNOXVILLE TN
37931-2813
US

V. Phone/Fax

Practice location:
  • Phone: 859-545-2300
  • Fax:
Mailing address:
  • Phone: 561-445-2332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CHAD FARMER
Title or Position: OWNER
Credential:
Phone: 859-545-2300