Healthcare Provider Details

I. General information

NPI: 1649568726
Provider Name (Legal Business Name): AA HOME HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 07/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 N POND DR STE 1
WALLED LAKE MI
48390-3080
US

IV. Provider business mailing address

55 N POND DR STE 1
WALLED LAKE MI
48390-3080
US

V. Phone/Fax

Practice location:
  • Phone: 248-905-1626
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberD6229H
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberD6229H
License Number StateMI

VIII. Authorized Official

Name: STELLA SHOR
Title or Position: OWNER
Credential:
Phone: 248-905-1626