Provider Demographics
NPI:1215562715
Name:AH HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:AH HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUENIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-205-4299
Mailing Address - Street 1:2801 CRISMAN ST STE 103-E
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-3847
Mailing Address - Country:US
Mailing Address - Phone:980-205-4299
Mailing Address - Fax:
Practice Address - Street 1:2801 CRISMAN ST STE 103-E
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-3847
Practice Address - Country:US
Practice Address - Phone:980-205-4299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care