=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134122450
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MMM HOME CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2005
-----------------------------------------------------
Last Update Date | 07/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1160 AIRWAY BLVD STE B6
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79925-3600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-757-1373
-----------------------------------------------------
Fax | 915-779-9814
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1160 AIRWAY BLVD STE B6
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79925-3600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-757-1373
-----------------------------------------------------
Fax | 915-779-9814
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING DIRECTOR
-----------------------------------------------------
Name | MR. THOMAS E REYNOLDS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 915-757-1373
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 007099
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------