=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487898490
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | POC HOME HEALTH AGENCY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2009
-----------------------------------------------------
Last Update Date | 04/22/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 3RD AVE NW
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55912-3141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-434-7488
-----------------------------------------------------
Fax | 507-434-9688
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 3RD AVE NW
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55912-3141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-434-7488
-----------------------------------------------------
Fax | 507-434-9688
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. OLA JIDE COKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 507-434-7488
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 343903
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------