=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578867784
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A-PLUS HOME HEALTH CARE AGENCY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2011
-----------------------------------------------------
Last Update Date | 03/14/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7008 ERIE ROAD SUITE 14
-----------------------------------------------------
City | DERBY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14047-9592
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-562-7012
-----------------------------------------------------
Fax | 716-562-7109
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 296
-----------------------------------------------------
City | DERBY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14047-9592
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-562-7012
-----------------------------------------------------
Fax | 716-562-7109
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. GWENDOLYN ECKLES
-----------------------------------------------------
Credential | LPN
-----------------------------------------------------
Telephone | 716-562-7012
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 1768L001
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------