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General NPI Number Information
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NPI Number | 1376913699
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Entity Type | Organization
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Legal Business Name | MELTON IN-HOME CARE, LLC
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Dates
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Enumeration Date | 09/29/2015
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Last Update Date | 09/29/2015
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Provider Practice Location Address
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Address Line | 1404 N MAIN ST
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City | SHELBYVILLE
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State | TN
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Zip | 37160-2381
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Country | US
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Telephone | 931-488-6863
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Fax | 931-488-6852
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Provider Business Mailing Address
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Address Line | 1404 N MAIN ST
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City | SHELBYVILLE
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State | TN
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Zip | 37160-2381
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Country | US
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Telephone | 931-488-6863
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Fax | 931-488-6852
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Authorized Official
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Title or Position | OWNER
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Name | MR. KENNETH JASON MELTON
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Credential |
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Telephone | 931-808-5247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 16393
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License Number State | TN
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