=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275911448
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAREPINE HOME HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2015
-----------------------------------------------------
Last Update Date | 04/06/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1125 S CEDAR CREST BLVD SUITE 204
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18103-7903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-550-7636
-----------------------------------------------------
Fax | 800-734-6065
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1125 S CEDAR CREST BLVD SUITE 204
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18103-7903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-550-7636
-----------------------------------------------------
Fax | 800-734-6065
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ELIUD OMOLLO
-----------------------------------------------------
Credential | MS
-----------------------------------------------------
Telephone | 484-550-7636
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------