Provider Demographics
NPI:1144760174
Name:PATRIOTS HOME HEALTH AID LLC
Entity Type:Organization
Organization Name:PATRIOTS HOME HEALTH AID LLC
Other - Org Name:PATRIOTS HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ADEYEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEROGBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-290-0291
Mailing Address - Street 1:26 W VILLARD ST
Mailing Address - Street 2:OFFICE 3B
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-5118
Mailing Address - Country:US
Mailing Address - Phone:701-491-0204
Mailing Address - Fax:701-575-7292
Practice Address - Street 1:26 W VILLARD ST
Practice Address - Street 2:OFFICE 3B
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-5118
Practice Address - Country:US
Practice Address - Phone:701-491-0204
Practice Address - Fax:701-575-7292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1469742251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care