=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437680865
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DT HOME CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2017
-----------------------------------------------------
Last Update Date | 03/27/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 BRKICH WAY STE 4
-----------------------------------------------------
City | BEAVER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15009-2947
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-382-8911
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 643 PHILLIPS RD
-----------------------------------------------------
City | BLAIRSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15717-4233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-382-8911
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DANIEL TOMLINSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 724-382-8911
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 30383601
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------