=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346819513
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADAMS COUNTY HOMECARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2021
-----------------------------------------------------
Last Update Date | 06/24/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19189 ST RT 136
-----------------------------------------------------
City | WINCHESTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45697
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-386-6015
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1404 N HIGH ST
-----------------------------------------------------
City | HILLSBORO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45133-8692
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-402-4010
-----------------------------------------------------
Fax | 937-402-4023
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | BAMBI RENEE JONES
-----------------------------------------------------
Credential | RN, BSN
-----------------------------------------------------
Telephone | 937-386-6015
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------