MEDICARE: YAHWEH YIREH HOST HOME SERVICE 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1821817461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YAHWEH YIREH HOST HOME SERVICE LLC

Provider Business Mailing Address
First Line	:	2101 MEADOW CT APT 404
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50320-4604
Country	:	US
Telephone Number	:	515-745-4121
Fax Number	:

Provider Business Practice Location Address
First Line	:	1570 E EMMA AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50320-1518
Country	:	US
Telephone Number	:	515-745-4121
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	HANCALTUU C ABDIISAA
Credential	:
Telephone Number	:	515-745-4121

Provider Enumeration Date	:	10/09/2024
Last Update Date	:	10/09/2024

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