=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487783676
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOBILITY PLUS HOMECARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2007
-----------------------------------------------------
Last Update Date | 12/18/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 SYCAMORE ST SUITE 136
-----------------------------------------------------
City | ELIZABETHTOWN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42701-2469
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-360-0486
-----------------------------------------------------
Fax | 270-360-1841
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 SYCAMORE ST SUITE 136
-----------------------------------------------------
City | ELIZABETHTOWN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42701-2469
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-360-0486
-----------------------------------------------------
Fax | 270-360-1841
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JEFFREY ALLAN AVERITT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 270-360-0486
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 221831
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------