Healthcare Provider Details

I. General information

NPI: 1881433811
Provider Name (Legal Business Name): AIDLIFE HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E ST STE 102-3
SAN RAFAEL CA
94901-2762
US

IV. Provider business mailing address

PO BOX 32663
SAN JOSE CA
95152-2663
US

V. Phone/Fax

Practice location:
  • Phone: 707-641-6006
  • Fax:
Mailing address:
  • Phone: 707-515-8234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH LIGGAYU
Title or Position: CHIEF OPERATING OFFICER
Credential: BSN-RN, PHN, PCCN
Phone: 707-515-8234