Provider Demographics
NPI:1609561067
Name:ANW HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:ANW HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KONAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-236-7133
Mailing Address - Street 1:515 PAMELA DR
Mailing Address - Street 2:
Mailing Address - City:BAY POINT
Mailing Address - State:CA
Mailing Address - Zip Code:94565-1533
Mailing Address - Country:US
Mailing Address - Phone:704-236-7133
Mailing Address - Fax:
Practice Address - Street 1:5167 LONE TREE WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8689
Practice Address - Country:US
Practice Address - Phone:925-529-2607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty