Provider Demographics
NPI:1922390749
Name:MAUREEN G HOLMGREN NIMMO
Entity Type:Organization
Organization Name:MAUREEN G HOLMGREN NIMMO
Other - Org Name:NIMMO HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:NIMMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-205-6624
Mailing Address - Street 1:867 DARNELL RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-6903
Mailing Address - Country:US
Mailing Address - Phone:270-205-6624
Mailing Address - Fax:270-933-4031
Practice Address - Street 1:867 DARNELL RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-6903
Practice Address - Country:US
Practice Address - Phone:270-205-6624
Practice Address - Fax:270-933-4031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY500128372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
615770800OtherDEPARTMENT OF LABOR