=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952783375
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IT'S STILL HOME LIFE CARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2015
-----------------------------------------------------
Last Update Date | 06/22/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17821 VIOLET LN
-----------------------------------------------------
City | ELGIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78621-5917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-686-4458
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17821 VIOLET LN
-----------------------------------------------------
City | ELGIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78621-5917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-686-4458
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, ADMINISTRATOR
-----------------------------------------------------
Name | TRACI RENEE BOYLE
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 512-686-4458
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------