=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962830778
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HHCCPS.LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2013
-----------------------------------------------------
Last Update Date | 10/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1116 DOUGLAS PL
-----------------------------------------------------
City | GALLATIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37066-5620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-713-0631
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1116 DOUGLAS PL
-----------------------------------------------------
City | GALLATIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37066-5620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-713-0631
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. LAWRENCE GOODMAN
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 615-713-0631
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 89954
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------