MEDICARE: AGING CARE HOME HEALTH, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	420	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902809965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGING CARE HOME HEALTH, INC.

Provider Business Mailing Address
First Line	:	101 N 2ND ST
Second Line	:	STE 101
City	:	WEST MONROE
State	:	LA
Zip	:	71291-3253
Country	:	US
Telephone Number	:	318-324-9076
Fax Number	:	318-324-9088

Provider Business Practice Location Address
First Line	:	101 N 2ND ST
Second Line	:	STE 101
City	:	WEST MONROE
State	:	LA
Zip	:	71291-3253
Country	:	US
Telephone Number	:	318-324-9076
Fax Number	:	318-324-9088

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. OTIS E DAVIS
Credential	:
Telephone Number	:	318-324-9076

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	08/22/2020

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