Healthcare Provider Details

I. General information

NPI: 1689352197
Provider Name (Legal Business Name): AMA HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 07/06/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N9353 S. LAKE PARK RD. 124
APPLETON WI
54915
US

IV. Provider business mailing address

4321 W COLLEGE AVE APT SUITE200
APPLETON WI
54914-3966
US

V. Phone/Fax

Practice location:
  • Phone: 920-939-9047
  • Fax:
Mailing address:
  • Phone: 920-939-9047
  • 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. ALIOUNE THIAM
Title or Position: MANAGING PARTNER
Credential:
Phone: 920-939-9047