=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669444154
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELEVEN ASH INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2006
-----------------------------------------------------
Last Update Date | 02/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5276 SUMMERLIN COMMONS WAY 702
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33907-2159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-275-4747
-----------------------------------------------------
Fax | 239-275-4210
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5276 SUMMERLIN COMMONS WAY SUITE 702
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-275-4747
-----------------------------------------------------
Fax | 239-275-4210
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. CHARLENE MILLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 239-275-4747
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HHA20441096
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------