Provider Demographics
NPI:1235583725
Name:ANNIES HOME CARE AND CLEANING SERVICES LLC
Entity Type:Organization
Organization Name:ANNIES HOME CARE AND CLEANING SERVICES LLC
Other - Org Name:ANNIES&ELOHIM HOMEHEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEAN DE DIEU
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:NITEZEHO NIYOMUGABO
Authorized Official - Suffix:
Authorized Official - Credentials:HOME CARE AIDE
Authorized Official - Phone:701-891-8809
Mailing Address - Street 1:100 E EUCLID AVE STE 127
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50313-4582
Mailing Address - Country:US
Mailing Address - Phone:701-891-8809
Mailing Address - Fax:
Practice Address - Street 1:100 E EUCLID AVE STE 127
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50313-4582
Practice Address - Country:US
Practice Address - Phone:701-891-8809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251E00000X, 251J00000X, 253Z00000X, 343900000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Single Specialty