Provider Demographics
NPI:1174737860
Name:CORNER HOMECARE
Entity type:Organization
Organization Name:CORNER HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:K
Authorized Official - Last Name:PPOOL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:270-365-3903
Mailing Address - Street 1:108 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:KY
Mailing Address - Zip Code:42445-2250
Mailing Address - Country:US
Mailing Address - Phone:270-365-3903
Mailing Address - Fax:270-365-2024
Practice Address - Street 1:546 LONE OAK RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-4538
Practice Address - Country:US
Practice Address - Phone:270-443-3311
Practice Address - Fax:270-442-7710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BC3200X, 332BN1400X, 332BP3500X, 333600000X, 335E00000X, 332BX2000X
KYP02404332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY45001559Medicaid
KY54005335Medicaid
KY90310731Medicaid
KY54029509Medicaid
IL=========002Medicaid
KY54005335Medicaid