Provider Demographics
NPI:1699582619
Name:AL FATH HOME CARE LLC
Entity type:Organization
Organization Name:AL FATH HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:OLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-655-0674
Mailing Address - Street 1:22106 CYMAN AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-3672
Mailing Address - Country:US
Mailing Address - Phone:313-655-0674
Mailing Address - Fax:
Practice Address - Street 1:22106 CYMAN AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-3672
Practice Address - Country:US
Practice Address - Phone:313-655-0674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care