=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588934020
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APEX K HOMECARE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2011
-----------------------------------------------------
Last Update Date | 12/30/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 65 SOUTHBRIDGE ST SUITE 220
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01501-2566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-243-1179
-----------------------------------------------------
Fax | 774-243-1189
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 65 SOUTHBRIDGE ST SUITE 220
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01501-2566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-243-1179
-----------------------------------------------------
Fax | 774-243-1189
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JOHNSON KARUE
-----------------------------------------------------
Credential | REGISTERED NURSE
-----------------------------------------------------
Telephone | 774-243-1179
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------