Provider Demographics
NPI:1619929734
Name:ASSISTED HOME RECOVERY, INC.
Entity Type:Organization
Organization Name:ASSISTED HOME RECOVERY, INC.
Other - Org Name:ASSISTED HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GERD
Authorized Official - Middle Name:F
Authorized Official - Last Name:KERSWILL
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:805-371-9988
Mailing Address - Street 1:72 MOODY COURT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-6067
Mailing Address - Country:US
Mailing Address - Phone:805-371-9988
Mailing Address - Fax:805-371-9987
Practice Address - Street 1:4450 WESTINGHOUSE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5787
Practice Address - Country:US
Practice Address - Phone:805-677-2100
Practice Address - Fax:805-677-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA050000513251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08039FMedicaid
CA05-8039Medicare ID - Type Unspecified