Provider Demographics
NPI:1275024622
Name:IMMEDIATE HOME CARE AGENCY LLC
Entity Type:Organization
Organization Name:IMMEDIATE HOME CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSSUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-814-7838
Mailing Address - Street 1:3730 S 148TH ST APT 56
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-4364
Mailing Address - Country:US
Mailing Address - Phone:206-643-7815
Mailing Address - Fax:
Practice Address - Street 1:6727 MLK JR WAY S STE C
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-3205
Practice Address - Country:US
Practice Address - Phone:206-643-7815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care