Provider Demographics
NPI:1285010884
Name:AETNA HOME HEALTH SERVICE
Entity Type:Organization
Organization Name:AETNA HOME HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:M
Authorized Official - Last Name:BULAMBO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:210-630-0030
Mailing Address - Street 1:8100 ROUGHRIDER DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78239
Mailing Address - Country:US
Mailing Address - Phone:210-900-0729
Mailing Address - Fax:
Practice Address - Street 1:8100 ROUGHRIDER DR
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78239
Practice Address - Country:US
Practice Address - Phone:210-900-0729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health