=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063910487
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOME CARE BUDDY SYSTEM, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2018
-----------------------------------------------------
Last Update Date | 01/31/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 78 DARLINGTON RD
-----------------------------------------------------
City | BEAVER FALLS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15010-3153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-494-9127
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 78 DARLINGTON RD
-----------------------------------------------------
City | BEAVER FALLS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15010-3153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | ANDREW RIMOLDI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 724-494-9127
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 36353601
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------