=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205173291
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IN-HOME SUPPORT SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2013
-----------------------------------------------------
Last Update Date | 01/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 121 W LOCUST ST SUITE 109
-----------------------------------------------------
City | CULPEPER
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22701-3160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-727-9539
-----------------------------------------------------
Fax | 540-727-9549
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 121 W LOCUST ST SUITE 109
-----------------------------------------------------
City | CULPEPER
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22701-3160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-727-9539
-----------------------------------------------------
Fax | 540-727-9549
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | ALAPHIA THOMAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 540-727-9539
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HCO-13322
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------