Provider Demographics
NPI:1407336639
Name:BLACK PEARL HOME CARE
Entity Type:Organization
Organization Name:BLACK PEARL HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KWAME
Authorized Official - Middle Name:
Authorized Official - Last Name:DUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-917-1444
Mailing Address - Street 1:1712 HIGHWAY 121 BYP N STE C
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-8864
Mailing Address - Country:US
Mailing Address - Phone:270-917-1444
Mailing Address - Fax:270-917-1400
Practice Address - Street 1:1712 HIGHWAY 121 BYP N STE C
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-8864
Practice Address - Country:US
Practice Address - Phone:270-917-1444
Practice Address - Fax:270-917-1400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY500293253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care