=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932984184
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEPPERMINT PALM HOME HEALTH CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2023
-----------------------------------------------------
Last Update Date | 08/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9800 SE 163RD LN
-----------------------------------------------------
City | SUMMERFIELD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34491-5948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-212-9987
-----------------------------------------------------
Fax | 888-962-6462
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10017 FEDERALIST LN
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95827-1934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-212-9987
-----------------------------------------------------
Fax | 888-962-6462
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ALFEAR NELSON WRIGHT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 916-212-9987
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------