Healthcare Provider Details

I. General information

NPI: 1922232164
Provider Name (Legal Business Name): IN HIS NAME HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2009
Last Update Date: 05/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 S HIGH ST
BRIDGTON ME
04009-4102
US

IV. Provider business mailing address

187 S HIGH ST
BRIDGTON ME
04009-4102
US

V. Phone/Fax

Practice location:
  • Phone: 207-647-8718
  • Fax: 207-647-8778
Mailing address:
  • Phone: 207-647-8718
  • Fax: 207-647-8778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CHRISTY LYNN HAFFORD
Title or Position: ADMINISTRATOR
Credential: CNA
Phone: 297-647-8718