=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932836632
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENEROUS LEADERS HOMECARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2022
-----------------------------------------------------
Last Update Date | 08/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1111 W BROAD ST REAR
-----------------------------------------------------
City | BETHLEHEM
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18018-4955
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-606-1165
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1441 BUTLER ST APT A1
-----------------------------------------------------
City | EASTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18042-7800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-536-0032
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. KIMEL BROWN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 347-536-0032
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------