MEDICARE: HICKORY HOME HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	77850501	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1834	OTHER	PA	INSURANCE

General Provider Information

NPI Number	:	1053378299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HICKORY HOME HEALTH

Provider Business Mailing Address
First Line	:	120 PERRY RD
Second Line	:
City	:	BURGETTSTOWN
State	:	PA
Zip	:	15021-2416
Country	:	US
Telephone Number	:	724-356-2260
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 PERRY RD
Second Line	:
City	:	BURGETTSTOWN
State	:	PA
Zip	:	15021-2416
Country	:	US
Telephone Number	:	724-356-2260
Fax Number	:

Authorized Official
Title or Position	:	ASST. ADMINISTRATOR
Name	:	MRS. AMANDA LOWE
Credential	:
Telephone Number	:	724-326-2260

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	09/26/2007

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Directions to “HICKORY HOME HEALTH ” Practice Location

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