=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508289935
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VALIQUET HEALTHCARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/21/2014
-----------------------------------------------------
Last Update Date | 01/21/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 833 HILLBROOK LN
-----------------------------------------------------
City | LANGHORNE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19047-8510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-645-0831
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 833 HILLBROOK LN
-----------------------------------------------------
City | LANGHORNE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19047-8510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-645-0831
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF NURSING/ADMINISTRATOR
-----------------------------------------------------
Name | FUNMILAYO JENNIFER WHITAKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 484-645-0831
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | RN601756
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------