=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780124347
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARVEST HOME CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2017
-----------------------------------------------------
Last Update Date | 03/02/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2407 SCHILLING ST APT C
-----------------------------------------------------
City | MISSOULA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59801-7548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-214-3053
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2407 SCHILLING ST APT C
-----------------------------------------------------
City | MISSOULA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59801-7548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | KALEY M BURKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 406-214-3053
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 2016MSSGEN00386
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------