=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851935993
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BROOKS HOME HEALTH CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2019
-----------------------------------------------------
Last Update Date | 11/01/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 52 E OAK ST
-----------------------------------------------------
City | WEST ALEXANDRIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45381-1273
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-701-5080
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 52 E OAK ST
-----------------------------------------------------
City | WEST ALEXANDRIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45381-1273
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-701-5080
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER
-----------------------------------------------------
Name | LISA R HENDERSON
-----------------------------------------------------
Credential | BSN, RN
-----------------------------------------------------
Telephone | 937-701-5080
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WH0200X
-----------------------------------------------------
Taxonomy Name | Home Health Registered Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------