MEDICARE: WAKEFIELDS HOME HEALTH & IMPROVEMENT

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	305S00000X	Point of Service

General Provider Information

NPI Number	:	1225574817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAKEFIELDS HOME HEALTH & IMPROVEMENT

Provider Business Mailing Address
First Line	:	1108 LONGFIELD AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40215-2728
Country	:	US
Telephone Number	:	513-410-4757
Fax Number	:

Provider Business Practice Location Address
First Line	:	1108 LONGFIELD AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40215-2728
Country	:	US
Telephone Number	:	513-410-4757
Fax Number	:

Authorized Official
Title or Position	:	CARE GIVER
Name	:	KELLY WAKEFIELD
Credential	:	CNA
Telephone Number	:	513-410-4757

Provider Enumeration Date	:	01/06/2017
Last Update Date	:	01/06/2017

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