Provider Demographics
NPI:1629082953
Name:21ST CENTURY HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:21ST CENTURY HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAUF
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-266-7128
Mailing Address - Street 1:4235 LAKE ST EAST SIDE
Mailing Address - Street 2:
Mailing Address - City:BRIDGMAN
Mailing Address - State:MI
Mailing Address - Zip Code:49106-9109
Mailing Address - Country:US
Mailing Address - Phone:269-266-7128
Mailing Address - Fax:269-266-7178
Practice Address - Street 1:4235 LAKE ST EAST SIDE
Practice Address - Street 2:
Practice Address - City:BRIDGMAN
Practice Address - State:MI
Practice Address - Zip Code:49106-9109
Practice Address - Country:US
Practice Address - Phone:269-266-7128
Practice Address - Fax:269-266-7178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI237797Medicare Oscar/Certification