=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184157331
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOPE CARE TEAM, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2017
-----------------------------------------------------
Last Update Date | 05/09/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3615 NEWMARK DR
-----------------------------------------------------
City | MIAMISBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-813-8026
-----------------------------------------------------
Fax | 937-949-3759
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3615 NEWMARK DR
-----------------------------------------------------
City | MIAMISBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-813-8026
-----------------------------------------------------
Fax | 937-949-3759
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | RYAN MULLIKIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 937-294-2273
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------