=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780279018
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELGIN HANDS HOME HEALTHCARE SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2021
-----------------------------------------------------
Last Update Date | 12/20/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4973 BRISTOL ROCK RD
-----------------------------------------------------
City | BLACK JACK
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63033-7530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-761-1901
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4973 BRISTOL ROCK RD
-----------------------------------------------------
City | BLACK JACK
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63033-7530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-761-1901
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. SHERMAINE WHITT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-761-1901
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------