=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881339257
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GIFTED HANDS OF CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2022
-----------------------------------------------------
Last Update Date | 05/01/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 214 S 23RD ST
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62521-3131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-330-7566
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 214 S 23RD ST
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62521-3131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-330-7566
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AGENCY MANGER/ OWNER
-----------------------------------------------------
Name | ERYK BURTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 217-520-3857
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------