MEDICARE: GREAT HOME HEALTHCARE & MORE

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

General Provider Information

NPI Number	:	1881026839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT HOME HEALTHCARE & MORE

Provider Business Mailing Address
First Line	:	1006 NICKERSON AVE
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-6118
Country	:	US
Telephone Number	:	269-934-0221
Fax Number	:	269-934-0476

Provider Business Practice Location Address
First Line	:	1006 NICKERSON AVE
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-6118
Country	:	US
Telephone Number	:	269-934-0221
Fax Number	:	269-934-0476

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. VALERIEQ LYNN FULTON
Credential	:
Telephone Number	:	269-934-0221

Provider Enumeration Date	:	08/01/2013
Last Update Date	:	08/01/2013

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