MEDICARE: AA HOME HEALTH CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	313M00000X	Nursing Facility/Intermediate Care Facility	D6229H	MI
2	251E00000X	Home Health Agency	D6229H	MI

General Provider Information

NPI Number	:	1649568726
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AA HOME HEALTH CARE, LLC

Provider Business Mailing Address
First Line	:	55 N POND DR STE 1
Second Line	:
City	:	WALLED LAKE
State	:	MI
Zip	:	48390-3080
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 N POND DR STE 1
Second Line	:
City	:	WALLED LAKE
State	:	MI
Zip	:	48390-3080
Country	:	US
Telephone Number	:	248-905-1626
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STELLA SHOR
Credential	:
Telephone Number	:	248-905-1626

Provider Enumeration Date	:	07/11/2011
Last Update Date	:	07/11/2011

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Directions to “AA HOME HEALTH CARE, LLC ” Practice Location

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