=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033189345
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PERSONAL TOUCH HOME CARE OF KY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2006
-----------------------------------------------------
Last Update Date | 01/11/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 GRAND AVE
-----------------------------------------------------
City | FT. THOMAS
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-441-0200
-----------------------------------------------------
Fax | 859-441-0537
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22215 NORTHERN BLVD
-----------------------------------------------------
City | BAYSIDE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11361-3603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-468-4747
-----------------------------------------------------
Fax | 718-736-7236
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/BOARD MEMBER
-----------------------------------------------------
Name | ROBERT MARX
-----------------------------------------------------
Credential | ESQ.
-----------------------------------------------------
Telephone | 718-468-4747
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 150111
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------