=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083131239
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EYPR OME HEALTH CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2017
-----------------------------------------------------
Last Update Date | 06/20/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9850 BERNWOOD PLACE DR APT 109
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33966-6904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-887-3114
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 51331
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33994-1331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-887-3114
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MISS ENID Y PEREZ RIVERA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 239-887-3114
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 235005
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------