Provider Demographics
NPI:1841297157
Name:AHCCK LLC
Entity type:Organization
Organization Name:AHCCK LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BANGERTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-397-4000
Mailing Address - Street 1:576 W. 900 S.
Mailing Address - Street 2:SUITE 260
Mailing Address - City:WOOD CROSS
Mailing Address - State:UT
Mailing Address - Zip Code:84010-8127
Mailing Address - Country:US
Mailing Address - Phone:801-397-4054
Mailing Address - Fax:801-397-4196
Practice Address - Street 1:9370 W STOCKTON BLVD
Practice Address - Street 2:STE 130
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-8013
Practice Address - Country:US
Practice Address - Phone:916-691-4100
Practice Address - Fax:916-691-4111
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCKY MOUNTAIN HOME HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-30
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100000487251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA07404GMedicaid
CACGP166248OtherCALIFORNIA CHILDREN SERVICES
CAZZZ03663ZOtherBLUE SHIELD OF CALIFORNIA
CA057404Medicare Oscar/Certification