=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144529421
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOMECARE BY PAULETT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2011
-----------------------------------------------------
Last Update Date | 03/25/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 696 WESTBROOK ST APT 3I
-----------------------------------------------------
City | SOUTH PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04106-1957
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 134-766-8612
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 696 WESTBROOK ST APT 3I
-----------------------------------------------------
City | SOUTH PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 134-766-8612
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. ANDRE WAYNE FORRESTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 347-668-6122
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number | NONE
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------