1104136548 NPI number — AMARA HOME HEALTH, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104136548 NPI number — AMARA HOME HEALTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMARA HOME HEALTH, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104136548
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
175 N JACKSON AVE STE 103A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95116-1912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-258-5803
Provider Business Mailing Address Fax Number:
408-258-5830

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
175 N JACKSON AVE
Provider Second Line Business Practice Location Address:
SUITE 103-A
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95116-1909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-258-5803
Provider Business Practice Location Address Fax Number:
408-258-5830
Provider Enumeration Date:
10/19/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SUOR
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
858-251-4242

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  070000304 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HHA57441F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".