Provider Demographics
NPI:1518439827
Name:ABSALOM HOME HEALTH AGENCY LLC
Entity Type:Organization
Organization Name:ABSALOM HOME HEALTH AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOWOE
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:619-754-3441
Mailing Address - Street 1:3602 TAVARA CIR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-3752
Mailing Address - Country:US
Mailing Address - Phone:617-754-3441
Mailing Address - Fax:
Practice Address - Street 1:1283 E MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-7252
Practice Address - Country:US
Practice Address - Phone:858-252-3678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-27
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health