=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578379046
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 7TH AND HENDRIX HOME CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2024
-----------------------------------------------------
Last Update Date | 12/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9813 WAY AVE
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44105-2316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 980-439-3165
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16109 DELANEY DR APT 16109
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28027-8289
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 980-439-3165
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TIA PLUMMER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 980-439-3165
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------