Eminence Healthcare Staffing Agency LLC.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

EMINENCE HEALTHCARE STAFFING AGENCY LLC.

Doing business as

Eminence Health & Notary Services

Practice address

2015 W Western Ave Ste 201
South Bend, IN 46619-3558

Phone

(866) 350-6400

NPI assigned

Feb 20, 2018

Last updated

Aug 22, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Heidi Davonne Brown, AASNPI 1356841944

Title

Owner, MD, Ceo

Phone

(866) 350-6400

Specialties & licenses 8

Addresses

Other names 1

• Eminence Health & Notary Services Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Heidi Davonne Brown, LPN, CMLD, CEO

  • Licensed Practical Nurse
  • South Bend, IN
  • NPI 1356841944
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1519084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629590400000",
    "number": "1720588221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2015 W WESTERN AVE STE 201",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466193558",
            "telephone_number": "866-350-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 W WESTERN AVE STE 201",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466193558",
            "telephone_number": "866-350-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMINENCE HEALTHCARE STAFFING AGENCY LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-20",
        "last_updated": "2021-08-22",
        "certification_date": "2021-08-22",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "HEIDI",
        "authorized_official_middle_name": "DAVONNE",
        "authorized_official_title_or_position": "OWNER, MD, CEO",
        "authorized_official_telephone_number": "866-350-6400",
        "authorized_official_credential": "AAS"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "IN",
            "license": "27075427A",
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": "IN",
            "license": null,
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "IN",
            "license": null,
            "primary": false
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eminence Health & Notary Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Eminence Health & Notary Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Medical Laboratory in South Bend, IN
• Providers in South Bend, IN by specialty
• Clinical Medical Laboratory in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.