=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003120023
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOME HEALTH AGENCY-CENTRAL PENNSYLVANIA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2010
-----------------------------------------------------
Last Update Date | 07/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 873 CLARE LN
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17402-4317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-650-2778
-----------------------------------------------------
Fax | 717-650-2787
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 510 HOSPITAL DR SUITE 100
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37115-5033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-712-2250
-----------------------------------------------------
Fax | 615-577-0081
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MR. JORGE RICO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-476-5160
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 2720501
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------