1205196334 NPI number — AAG IN HOME CARE LLC

Table of content: (NPI 1205196334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205196334 NPI number — AAG IN HOME CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AAG IN HOME CARE 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:
6
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:
1205196334
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 SCHUYLER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLENDALE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07401-1837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-846-9067
Provider Business Mailing Address Fax Number:
866-459-9641

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1541 ALTA DR STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITEHALL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18052-5632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-353-1210
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KAY
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER, PRESIDENT AND ADMINISTRATOR
Authorized Official Telephone Number:
484-353-1210

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  04930501 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 103403459-0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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