Healthcare Provider Details

I. General information

NPI: 1770968554
Provider Name (Legal Business Name): CONVENIENCE HOME HEALTH-AIDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2015
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 N WEST AVE APT 305
SIOUX FALLS SD
57104-5740
US

IV. Provider business mailing address

809 N WEST AVE APT 305
SIOUX FALLS SD
57104-5740
US

V. Phone/Fax

Practice location:
  • Phone: 605-251-5174
  • Fax:
Mailing address:
  • Phone: 605-251-5174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. HUSSEIN MUHUMED GUDAL
Title or Position: MANAGER
Credential:
Phone: 605-251-5174