Healthcare Provider Details

I. General information

NPI: 1336181890
Provider Name (Legal Business Name): A-1 HOME HEALTHCARE SERVICE CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 1ST AVE SE
CEDAR RAPIDS IA
52402-6001
US

IV. Provider business mailing address

3223 1ST AVE SE
CEDAR RAPIDS IA
52402-6001
US

V. Phone/Fax

Practice location:
  • Phone: 319-362-1084
  • Fax: 319-366-8972
Mailing address:
  • Phone: 319-362-1084
  • Fax: 319-366-8972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5857
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0254177
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 2
Identifier115979
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerBLUE CROSS PROVIDER NO
# 3
Identifier0128439
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: ROSE C LIND
Title or Position: PRESIDENT
Credential:
Phone: 515-955-1654