=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508327198
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEO HOME HEALTH CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2019
-----------------------------------------------------
Last Update Date | 03/27/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1203 MILAN ST
-----------------------------------------------------
City | NORTH PORT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34286-6103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-244-5468
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1203 MILAN ST
-----------------------------------------------------
City | NORTH PORT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34286-6103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-244-5468
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. CORNELIUS MARTIN MCKEE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 423-244-5468
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD1600X
-----------------------------------------------------
Taxonomy Name | Developmental Disabilities Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------