Provider Demographics
NPI:1184748584
Name:THE HOME HEALTH AGENCY LLC
Entity type:Organization
Organization Name:THE HOME HEALTH AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MELLOTT
Authorized Official - Suffix:
Authorized Official - Credentials:RNC
Authorized Official - Phone:307-334-0177
Mailing Address - Street 1:PO BOX 577
Mailing Address - Street 2:
Mailing Address - City:LUSK
Mailing Address - State:WY
Mailing Address - Zip Code:82225-0577
Mailing Address - Country:US
Mailing Address - Phone:307-334-0177
Mailing Address - Fax:307-334-0179
Practice Address - Street 1:201 W 3RD STREET
Practice Address - Street 2:
Practice Address - City:LUSK
Practice Address - State:WY
Practice Address - Zip Code:82225-0577
Practice Address - Country:US
Practice Address - Phone:307-334-0177
Practice Address - Fax:307-334-0179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY07005251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health