=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295273514
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PINK HALO HOME HEALTHCARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2017
-----------------------------------------------------
Last Update Date | 02/07/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 723 ENCLAVE VILLAGE PL APT 5
-----------------------------------------------------
City | LEWIS CENTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43035-7540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-596-0119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 723 ENCLAVE VILLAGE PL APT 5
-----------------------------------------------------
City | LEWIS CENTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43035-7540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-596-0119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | HONG NINH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 614-596-0119
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------