=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205215142
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REFORMATION HOME HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2015
-----------------------------------------------------
Last Update Date | 05/26/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 412 S. SAGINAW ST SUITE 301
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-513-0202
-----------------------------------------------------
Fax | 313-202-8313
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3014 YALE ST
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48503-6800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-513-0202
-----------------------------------------------------
Fax | 313-202-8313
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | ERICA BIGELOW
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 810-513-0202
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------