=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043509581
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMPATHIC HOMECARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2011
-----------------------------------------------------
Last Update Date | 04/05/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 521 N BROADWAY SUITE 3
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55906-3664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-202-9414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 521 N BROADWAY SUITE 3
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55906-3664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-202-9414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HUMAN RESOURCE
-----------------------------------------------------
Name | MUSTAF A FARAH
-----------------------------------------------------
Credential | BA
-----------------------------------------------------
Telephone | 507-202-9414
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------