=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548068422
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MY HOME HEALTHCARE AGENCY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2025
-----------------------------------------------------
Last Update Date | 03/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 181 KING RD NW
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35806-3403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-577-0590
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11515 OLD LOTTSFORD RD
-----------------------------------------------------
City | BOWIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20721-2277
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-577-0590
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. YONNETTE EVELYN SEMPLE-DORMER
-----------------------------------------------------
Credential | EDD
-----------------------------------------------------
Telephone | 508-577-0590
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------