Provider Demographics
NPI:1164103586
Name:LILY'S OF THE VALLEY HOME CARE LLC
Entity Type:Organization
Organization Name:LILY'S OF THE VALLEY HOME CARE LLC
Other - Org Name:EXECUTIVE HOME HEALTHCARE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAHARLA
Authorized Official - Middle Name:DAHIR
Authorized Official - Last Name:EID
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:170-194-1006
Mailing Address - Street 1:2601 18TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6603
Mailing Address - Country:US
Mailing Address - Phone:701-941-0062
Mailing Address - Fax:
Practice Address - Street 1:2601 18TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6603
Practice Address - Country:US
Practice Address - Phone:701-941-0062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-27
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care