Healthcare Provider Details

I. General information

NPI: 1205855640
Provider Name (Legal Business Name): IN HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 NOTTINGHAM AVE
WISE VA
24293-5612
US

IV. Provider business mailing address

201 NOTTINGHAM AVE
WISE VA
24293-5612
US

V. Phone/Fax

Practice location:
  • Phone: 276-329-9340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: YVONNE WHITAKER
Title or Position: SECRETARY CORP
Credential:
Phone: 276-329-9340