=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033641311
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOPE HOUSE HOME HEALTH CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2017
-----------------------------------------------------
Last Update Date | 11/12/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 517 S KEYSTONE AVE
-----------------------------------------------------
City | SAYRE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18840-1560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-731-4601
-----------------------------------------------------
Fax | 570-731-4636
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 517 S KEYSTONE AVE
-----------------------------------------------------
City | SAYRE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18840-1560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-731-4601
-----------------------------------------------------
Fax | 570-731-4636
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | HOPE VANDERGRIFT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 607-207-7826
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------