=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366774960
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARRELL'S HOME HEALTHCARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2010
-----------------------------------------------------
Last Update Date | 04/20/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 133 W JACKSON ST
-----------------------------------------------------
City | CAYUGA
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47928-8022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-492-9000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 133 W JACKSON ST
-----------------------------------------------------
City | CAYUGA
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47928-8022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-492-9000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/OWNER
-----------------------------------------------------
Name | MRS. CARA L HARRELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 765-492-9000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------