Healthcare Provider Details

I. General information

NPI: 1629082953
Provider Name (Legal Business Name): 21ST CENTURY HOME HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4235 LAKE ST EAST SIDE
BRIDGMAN MI
49106-9109
US

IV. Provider business mailing address

4235 LAKE ST EAST SIDE
BRIDGMAN MI
49106-9109
US

V. Phone/Fax

Practice location:
  • Phone: 269-266-7128
  • Fax: 269-266-7178
Mailing address:
  • Phone: 269-266-7128
  • Fax: 269-266-7178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. RAUF AHMAD
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 269-266-7128