Provider Demographics
NPI:1104460138
Name:ARYEA GROUP LLC
Entity type:Organization
Organization Name:ARYEA GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUELLA
Authorized Official - Middle Name:N
Authorized Official - Last Name:GWANMESIA
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:651-447-9854
Mailing Address - Street 1:PO BOX 1340
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-1339
Mailing Address - Country:US
Mailing Address - Phone:651-447-9854
Mailing Address - Fax:651-493-8895
Practice Address - Street 1:5002 CHARISMA DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-8843
Practice Address - Country:US
Practice Address - Phone:651-447-9854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-02
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health