Healthcare Provider Details

I. General information

NPI: 1285963876
Provider Name (Legal Business Name): AK HOME HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 12/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 HOMEPLATE CT
O FALLON MO
63366-2040
US

IV. Provider business mailing address

39 HOMEPLATE CT
O FALLON MO
63366-2040
US

V. Phone/Fax

Practice location:
  • Phone: 314-951-8511
  • Fax: 314-776-6261
Mailing address:
  • Phone: 314-951-8511
  • Fax: 314-776-6261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. AHMED M. DIRIR
Title or Position: DIRECTOR
Credential:
Phone: 314-951-8511