=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346549748
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUESMAN HOME HEALTH SERVICE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2011
-----------------------------------------------------
Last Update Date | 03/24/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 MEDLOCK RD SIDE B
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40517-1148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-552-6454
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 250 MEDLOCK ROAD SIDE B
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40517-1148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-552-6454
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPERATOR/CEO
-----------------------------------------------------
Name | MRS. VIRGINIA DAY HUESMAN
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 859-552-6454
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number | 1067814
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------