Provider Demographics
NPI:1063184877
Name:KNOX COUNTY NON-MEDICAL HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:KNOX COUNTY NON-MEDICAL HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-681-0128
Mailing Address - Street 1:82 THOMPSON DR
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-5648
Mailing Address - Country:US
Mailing Address - Phone:812-681-0128
Mailing Address - Fax:
Practice Address - Street 1:82 THOMPSON DR
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-5648
Practice Address - Country:US
Practice Address - Phone:812-681-0128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-30
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No172A00000XOther Service ProvidersDriverGroup - Single Specialty
No174200000XOther Service ProvidersMeals
No372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN202101221454229Medicaid