Healthcare Provider Details

I. General information

NPI: 1215087820
Provider Name (Legal Business Name): HOME CONVALESCENT AIDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 03/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 W LEXINGTON AVE
WINCHESTER KY
40391-1169
US

IV. Provider business mailing address

1113 W LEXINGTON AVE
WINCHESTER KY
40391-1169
US

V. Phone/Fax

Practice location:
  • Phone: 859-745-4445
  • Fax: 859-745-0483
Mailing address:
  • Phone: 859-745-4445
  • Fax: 859-745-0483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. DONALD KENNETH DOVE
Title or Position: PRESIDENTPHARMACIST
Credential: RPH
Phone: 859-745-4445