=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699023754
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 1 ON 1 HOME HEALTH CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2012
-----------------------------------------------------
Last Update Date | 08/21/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2468 N STATE ROAD 39 SUITE D
-----------------------------------------------------
City | LA PORTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46350-2062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-324-2223
-----------------------------------------------------
Fax | 219-324-2224
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2468 N STATE ROAD 39 SUITE D
-----------------------------------------------------
City | LA PORTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46350-2062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-324-2223
-----------------------------------------------------
Fax | 219-324-2224
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. KATHERINE MARIE NEVEROSKI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 219-324-2223
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------