=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124569520
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IN HOME HEALTH CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2017
-----------------------------------------------------
Last Update Date | 03/17/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3506 GLENWOOD AVE
-----------------------------------------------------
City | YOUNGSTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44511-3280
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-518-7624
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3506 GLENWOOD AVE
-----------------------------------------------------
City | YOUNGSTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44511-3280
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | KRISTY L LENZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 330-518-7624
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 4004752
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------