Provider Demographics
NPI:1073266185
Name:AHAA VENTURES LLC
Entity Type:Organization
Organization Name:AHAA VENTURES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HESTLE DIANNE
Authorized Official - Middle Name:LAO
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-367-6554
Mailing Address - Street 1:3737 LAKE EASTBROOK BLVD SE STE 208
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-5944
Mailing Address - Country:US
Mailing Address - Phone:616-315-2200
Mailing Address - Fax:616-315-2201
Practice Address - Street 1:3737 LAKE EASTBROOK BLVD SE STE 208
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5944
Practice Address - Country:US
Practice Address - Phone:616-315-2200
Practice Address - Fax:616-315-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care