=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518928373
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOME HEALTH SERVICES OF MASON KIMBLE & MENARD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 717 E RAINEY ST
-----------------------------------------------------
City | MASON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-347-5145
-----------------------------------------------------
Fax | 325-347-6916
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 717 E RAINEY ST PO BOX 238
-----------------------------------------------------
City | MASON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-347-5145
-----------------------------------------------------
Fax | 325-347-6916
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RN ADM
-----------------------------------------------------
Name | MRS. SHERRY G MARTIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 325-347-5145
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 001334
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 002262
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------