Provider Demographics
NPI:1083476543
Name:ASSURED COMPANIONS AT HOME
Entity Type:Organization
Organization Name:ASSURED COMPANIONS AT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAYLISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-417-8505
Mailing Address - Street 1:2327 MCCORKINDALE PLZ APT 102
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68147-1589
Mailing Address - Country:US
Mailing Address - Phone:346-417-8505
Mailing Address - Fax:
Practice Address - Street 1:2327 MCCORKINDALE PLZ APT 102
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68147-1589
Practice Address - Country:US
Practice Address - Phone:346-417-8505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health