=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598702292
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HERITAGE HOME HEALTH SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2006
-----------------------------------------------------
Last Update Date | 09/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 432 S EMERSON AVE STE 220
-----------------------------------------------------
City | GREENWOOD
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46143-1952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-536-2290
-----------------------------------------------------
Fax | 765-342-8377
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7750 PARAGON RD
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45459-4050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-291-3780
-----------------------------------------------------
Fax | 765-342-8377
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COMPLIANCE OFFICER
-----------------------------------------------------
Name | TAMMY TURNMIRE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 937-291-3780
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 05-005294-2
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------