Provider Demographics
NPI:1780168757
Name:FOUR CORNERS HOME CARE
Entity type:Organization
Organization Name:FOUR CORNERS HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPY ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CHUMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-907-0392
Mailing Address - Street 1:993 VIXEN DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-2770
Mailing Address - Country:US
Mailing Address - Phone:859-907-0392
Mailing Address - Fax:
Practice Address - Street 1:993 VIXEN DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-2770
Practice Address - Country:US
Practice Address - Phone:859-907-0392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty