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General NPI Number Information
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NPI Number | 1578636411
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Entity Type | Organization
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Legal Business Name | 34HHA, INC
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 10/16/2015
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Provider Practice Location Address
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Address Line | 401 CENTER CT.
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City | BRIDGEPORT
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State | TX
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Zip | 76426
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Country | US
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Telephone | 940-683-3300
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Fax | 940-683-3302
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Provider Business Mailing Address
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Address Line | P.O. BOX 1298
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City | BRIDGEPORT
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State | TX
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Zip | 76426
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Country | US
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Telephone | 940-683-3300
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Fax | 940-683-3302
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. KIMBERLY K CANTRELL
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Credential | RN
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Telephone | 940-683-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 011650
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License Number State | TX
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