=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447848775
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXPERIENCE HOME HEALTH CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2021
-----------------------------------------------------
Last Update Date | 01/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 706 SLEEPY HOLLOW DR
-----------------------------------------------------
City | UNIONTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44685-9611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-622-1727
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 706 SLEEPY HOLLOW DR
-----------------------------------------------------
City | UNIONTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44685-9611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-622-1727
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | JASHA TANAI WILLIAMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 330-622-1727
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------