Provider Demographics
NPI:1790756393
Name:HOME CARE CLINIC AND SERVICES
Entity Type:Organization
Organization Name:HOME CARE CLINIC AND SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:606-279-2000
Mailing Address - Street 1:PO BOX 1327
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-1327
Mailing Address - Country:US
Mailing Address - Phone:606-279-2000
Mailing Address - Fax:606-279-5033
Practice Address - Street 1:2055 WOOTON RD
Practice Address - Street 2:
Practice Address - City:WOOTON
Practice Address - State:KY
Practice Address - Zip Code:41776-8751
Practice Address - Country:US
Practice Address - Phone:606-279-2000
Practice Address - Fax:606-279-5033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2560P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty