Healthcare Provider Details

I. General information

NPI: 1790442945
Provider Name (Legal Business Name): AAEN HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 VANDEVER AVE
WILMINGTON DE
19802-4403
US

IV. Provider business mailing address

907 VANDEVER AVE
WILMINGTON DE
19802-4403
US

V. Phone/Fax

Practice location:
  • Phone: 302-437-5943
  • Fax:
Mailing address:
  • Phone: 302-437-5943
  • 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 Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: NYDIA FULLE
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 302-437-5943