=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871580415
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOMECARE RESOURCES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1707 WARREN ST
-----------------------------------------------------
City | WINNSBORO
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71295-2939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-435-3342
-----------------------------------------------------
Fax | 318-435-5191
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1707 WARREN ST
-----------------------------------------------------
City | WINNSBORO
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71295-2939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-435-3342
-----------------------------------------------------
Fax | 318-435-5191
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. NOBLE ELLINGTON III
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 318-435-3342
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 992
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------