Provider Demographics
NPI:1093954711
Name:AMERIBEST HOME CARE, LLC
Entity Type:Organization
Organization Name:AMERIBEST HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANATAEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-925-3313
Mailing Address - Street 1:926-928 RACE ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-2437
Mailing Address - Country:US
Mailing Address - Phone:215-925-3313
Mailing Address - Fax:215-925-3828
Practice Address - Street 1:990 SPRING GARDEN ST STE 201
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-2606
Practice Address - Country:US
Practice Address - Phone:215-925-3313
Practice Address - Fax:215-925-3828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA02970501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021790530001Medicaid
PA398064OtherBRAVO HEALTH
PA1021790530001Medicaid