Healthcare Provider Details

I. General information

NPI: 1285230789
Provider Name (Legal Business Name): AMAR MUSA IDRIS HOMECARE AGENCY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 ROBERTS RD APT 2B
IOWA CITY IA
52246-2739
US

IV. Provider business mailing address

2650 ROBERTS RD APT 2B
IOWA CITY IA
52246-2739
US

V. Phone/Fax

Practice location:
  • Phone: 319-800-8180
  • Fax:
Mailing address:
  • Phone: 319-800-8180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: