Healthcare Provider Details

I. General information

NPI: 1053136267
Provider Name (Legal Business Name): ISSAA RESIDENTIAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 11/23/2024
Certification Date: 11/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 SUNNYSIDE LN
TOWNSEND DE
19734-9043
US

IV. Provider business mailing address

345 SUNNYSIDE LN
TOWNSEND DE
19734-9043
US

V. Phone/Fax

Practice location:
  • Phone: 302-507-7292
  • Fax:
Mailing address:
  • Phone: 302-507-7292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: SAM ABLOYOU MARZAR
Title or Position: PRESIDENT
Credential:
Phone: 302-507-7292