=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992126957
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CML HEALTH INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2013
-----------------------------------------------------
Last Update Date | 12/18/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 404 N GALENA AVE STE 110
-----------------------------------------------------
City | DIXON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61021-2115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-677-9657
-----------------------------------------------------
Fax | 815-677-9658
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 404 N GALENA AVE STE 110
-----------------------------------------------------
City | DIXON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61021-2115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-677-9657
-----------------------------------------------------
Fax | 815-677-9658
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | TY ROGERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 815-677-9657
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 3000965
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------