=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386646552
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF CALDWELL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2005
-----------------------------------------------------
Last Update Date | 06/10/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2345 MORGANTON BLVD SW
-----------------------------------------------------
City | LENOIR
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28645-4973
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-426-8401
-----------------------------------------------------
Fax | 828-426-8441
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2345 MORGANTON BLVD SW
-----------------------------------------------------
City | LENOIR
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28645-4973
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-426-8401
-----------------------------------------------------
Fax | 828-426-8441
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HOME HEALTH DIRECTOR
-----------------------------------------------------
Name | MRS. VALERIE CLARK KELLY
-----------------------------------------------------
Credential | CRNI
-----------------------------------------------------
Telephone | 828-426-8438
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251F00000X
-----------------------------------------------------
Taxonomy Name | Home Infusion Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HC0487
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------