=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902903461
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MORRISTOWN HAMBLEN HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2006
-----------------------------------------------------
Last Update Date | 02/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1633 W. MORRIS BLVD
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-586-9291
-----------------------------------------------------
Fax | 423-586-1463
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1633 W. MORRIS BLVD
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-586-9291
-----------------------------------------------------
Fax | 423-586-1463
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RN, PCM
-----------------------------------------------------
Name | MRS. CHERYL WYATT
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 423-586-9291
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 0000000153
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------