=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962490433
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REGIONAL HEALTH CARE PROFESSIONALS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2005
-----------------------------------------------------
Last Update Date | 01/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 525 W BRISTOL ST
-----------------------------------------------------
City | ELKHART
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46514-2964
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-295-9999
-----------------------------------------------------
Fax | 574-262-8888
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 147
-----------------------------------------------------
City | ELKHART
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46515-0147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-295-9999
-----------------------------------------------------
Fax | 574-262-8888
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | PAMELA J FAHLBECK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 574-295-9999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 04002407
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------