=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700052073
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOMMA'S HELPER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2008
-----------------------------------------------------
Last Update Date | 05/06/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2900 GORDON AVE SUITE 100
-----------------------------------------------------
City | SANTA CLARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95051-0718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-736-5315
-----------------------------------------------------
Fax | 866-264-4891
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2900 GORDON AVE SUITE 100
-----------------------------------------------------
City | SANTA CLARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95051-0718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-736-5315
-----------------------------------------------------
Fax | 866-264-4891
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. TANISHA NICOLE BILLOPS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 408-736-5315
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------