Provider Demographics
NPI:1679016919
Name:AHISKA HOMECARE LLC
Entity Type:Organization
Organization Name:AHISKA HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-632-6720
Mailing Address - Street 1:1450 S HAVANA ST UNIT 520
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012
Mailing Address - Country:US
Mailing Address - Phone:303-632-6720
Mailing Address - Fax:303-872-9120
Practice Address - Street 1:1450 S HAVANA ST UNIT 520
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4018
Practice Address - Country:US
Practice Address - Phone:303-632-6720
Practice Address - Fax:303-872-9120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04M462253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO26873273Medicaid