=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467782326
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HERNDON HOME HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2009
-----------------------------------------------------
Last Update Date | 12/28/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 36135 SCHOOLCRAFT RD
-----------------------------------------------------
City | LIVONIA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-246-0568
-----------------------------------------------------
Fax | 248-246-9617
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 36135 SCHOOLCRAFT RD
-----------------------------------------------------
City | LIVONIA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48150-1216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-246-0568
-----------------------------------------------------
Fax | 248-246-9617
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/COO
-----------------------------------------------------
Name | PATRICIA HERNDON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 248-246-0568
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------