Healthcare Provider Details

I. General information

NPI: 1093961765
Provider Name (Legal Business Name): AGING IN PLACE ASSISTIVE SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 21ST AVE SUITE 205
SAN FRANCISCO CA
94116-1208
US

IV. Provider business mailing address

2051 21ST AVE SUITE 205
SAN FRANCISCO CA
94116-1208
US

V. Phone/Fax

Practice location:
  • Phone: 415-661-6650
  • Fax: 480-393-5023
Mailing address:
  • Phone: 415-661-6650
  • Fax: 480-393-5023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number922291
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number922291
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number922291
License Number StateCA

VIII. Authorized Official

Name: MIKHAIL ZOTMAN
Title or Position: PRESIDENT
Credential: GENERAL CONTRACTOR
Phone: 415-661-6650