Provider Demographics
NPI:1962005025
Name:WESTERN KENTUCKY IN HOME PROVIDERS LLC
Entity Type:Organization
Organization Name:WESTERN KENTUCKY IN HOME PROVIDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEENA
Authorized Official - Middle Name:D
Authorized Official - Last Name:CARRICO
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:270-832-4826
Mailing Address - Street 1:1169 CARRICO RD
Mailing Address - Street 2:
Mailing Address - City:FANCY FARM
Mailing Address - State:KY
Mailing Address - Zip Code:42039
Mailing Address - Country:US
Mailing Address - Phone:270-832-4826
Mailing Address - Fax:
Practice Address - Street 1:1169 CARRICO RD
Practice Address - Street 2:
Practice Address - City:FANCY FARM
Practice Address - State:KY
Practice Address - Zip Code:42039
Practice Address - Country:US
Practice Address - Phone:270-832-4826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health