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General NPI Number Information
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NPI Number | 1003586447
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Entity Type | Organization
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Legal Business Name | CHUCKS HOME CARE AGENCY LLC
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Dates
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Enumeration Date | 09/16/2021
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Last Update Date | 09/16/2021
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Provider Practice Location Address
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Address Line | 416 E 5TH ST
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City | EAST LIVERPOOL
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State | OH
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Zip | 43920-3134
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Country | US
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Telephone | 724-252-6084
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Fax |
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Provider Business Mailing Address
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Address Line | 632 OLIVE LN
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City | AMBRIDGE
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State | PA
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Zip | 15003-2458
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Country | US
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Telephone | 724-680-5206
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MISS SHEREKA SIMMONS
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Credential |
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Telephone | 724-680-5206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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