=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477006682
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EPITOME HEALTHCARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2016
-----------------------------------------------------
Last Update Date | 07/25/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 NEW ENGLAND EXECUTIVE PARK
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01803-5202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 857-321-8671
-----------------------------------------------------
Fax | 187-752-7000
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1231
-----------------------------------------------------
City | LOCUST GROVE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30248-1231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 857-321-8671
-----------------------------------------------------
Fax | 187-738-7784
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | KEVIN HEAD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 857-321-8671
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------