=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366114639
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ON THE MISSION HOME HEALTHCARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2021
-----------------------------------------------------
Last Update Date | 07/31/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6311 RIME VILLAGE DR NW APT 816
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35806-4457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-384-4482
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 727 ARCADIA CIR NW STE C
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35801-5907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-429-9131
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JAMMIE MICHELLE BAKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 256-554-6295
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------