Provider Demographics
NPI:1629476866
Name:ARK OF LIFE HOME HEALTH, LLC
Entity Type:Organization
Organization Name:ARK OF LIFE HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOZHKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-682-3059
Mailing Address - Street 1:7 LAUREN LN
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-2574
Mailing Address - Country:US
Mailing Address - Phone:717-682-3059
Mailing Address - Fax:
Practice Address - Street 1:7 LAUREN LN
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-2574
Practice Address - Country:US
Practice Address - Phone:717-682-3059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05700501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health