Provider Demographics
NPI:1720444284
Name:HOPEWELL IN HOME SENIOR CARE
Entity Type:Organization
Organization Name:HOPEWELL IN HOME SENIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMI
Authorized Official - Middle Name:D
Authorized Official - Last Name:EDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-386-5552
Mailing Address - Street 1:2121 KILLARNEY WAY STE H
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-3400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:808 GORDON AVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6611
Practice Address - Country:US
Practice Address - Phone:850-386-5552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOPEWELL HOME HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA136R1307251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA4 11OtherHOME HEALTH AGENCY