=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114559234
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEIDI M DENNIES HOME HEALTH CARE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2020
-----------------------------------------------------
Last Update Date | 10/26/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8131 KENNEDY AVE
-----------------------------------------------------
City | HIGHLAND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46322-1128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-487-2090
-----------------------------------------------------
Fax | 219-513-6280
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8131 KENNEDY AVE
-----------------------------------------------------
City | HIGHLAND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46322-1128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-487-2090
-----------------------------------------------------
Fax | 219-513-6280
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number | 19-014535
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------