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General NPI Number Information
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NPI Number | 1629524988
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Entity Type | Organization
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Legal Business Name | FIREFLY HOME CARE LLC
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Dates
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Enumeration Date | 08/28/2016
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Last Update Date | 08/28/2016
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Provider Practice Location Address
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Address Line | 100 SOUTH MAIN STREET
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City | MIDDLEBURY
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State | IN
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Zip | 46540
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Country | US
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Telephone | 574-830-6121
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Fax |
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Provider Business Mailing Address
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Address Line | 100 SOUTH MAIN STREET P.O. BOX 4
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City | MIDDLEBURY
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State | IN
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Zip | 46540
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Country | US
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Telephone | 574-830-6121
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CLIENT SERVICES / OWNER
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Name | AMY MANIFOLD
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Credential | RN, BSN
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Telephone | 574-830-6121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 15-013021-1
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License Number State | IN
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