=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083757397
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCROGGINS NURSING AND HOME SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8550 W COUNTY ROAD 700 S
-----------------------------------------------------
City | COMMISKEY
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47227-9435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-873-8551
-----------------------------------------------------
Fax | 812-873-8552
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8550 W COUNTY ROAD 700 S
-----------------------------------------------------
City | COMMISKEY
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47227-9435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-873-8551
-----------------------------------------------------
Fax | 812-873-8552
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. KATHERINE JEAN SCROGGINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 812-873-8551
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 010088
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------