=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003283151
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KEEPING YOUR ROSE TIMELESS HOME CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2015
-----------------------------------------------------
Last Update Date | 08/25/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2010 E 148TH AVE APT 22
-----------------------------------------------------
City | LUTZ
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33549-4601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-284-8670
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2010 E 148TH AVE APT 22
-----------------------------------------------------
City | LUTZ
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33549-4601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-284-8670
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. LUCIAN CHAVETT KNOTT
-----------------------------------------------------
Credential | HHA /APD
-----------------------------------------------------
Telephone | 813-284-8670
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 27V215
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------