Provider Demographics
NPI:1679255491
Name:COMFORT AT HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:COMFORT AT HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUGUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ETILO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-989-3820
Mailing Address - Street 1:504 E INTERSTATE AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-1170
Mailing Address - Country:US
Mailing Address - Phone:701-989-3820
Mailing Address - Fax:
Practice Address - Street 1:504 E INTERSTATE AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-1170
Practice Address - Country:US
Practice Address - Phone:701-989-3820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health