=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013307065
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RB HOME HEALTH CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2015
-----------------------------------------------------
Last Update Date | 01/29/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 321 ARNOLD AVE
-----------------------------------------------------
City | PONTIAC
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48341-1061
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-255-5630
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 321 ARNOLD AVE
-----------------------------------------------------
City | PONTIAC
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48341-1061
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-255-5630
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | STEPHANIE HUMPRHIES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 248-255-5630
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | 000000000
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------