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General NPI Number Information
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NPI Number | 1699001503
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Entity Type | Organization
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Legal Business Name | KIWI HOME CARE
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Dates
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Enumeration Date | 10/27/2009
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Last Update Date | 10/27/2009
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Provider Practice Location Address
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Address Line | 101 COUNTRY DR
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City | COWAN
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State | TN
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Zip | 37318-3502
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Country | US
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Telephone | 931-636-8836
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 674
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City | SEWANEE
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State | TN
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Zip | 37375-0674
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Country | US
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Telephone | 931-636-8836
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. HILDA CUBBERLEY VAUGHAN
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Credential |
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Telephone | 931-636-8836
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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 | 1000000005498
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License Number State | TN
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