Provider Demographics
NPI:1689390882
Name:4A HOUSING LLC
Entity Type:Organization
Organization Name:4A HOUSING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOO
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-966-6384
Mailing Address - Street 1:V538 COUNTY ROAD 4A
Mailing Address - Street 2:
Mailing Address - City:LIBERTY CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43532-8512
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:V538 COUNTY ROAD 4A
Practice Address - Street 2:
Practice Address - City:LIBERTY CENTER
Practice Address - State:OH
Practice Address - Zip Code:43532-8512
Practice Address - Country:US
Practice Address - Phone:419-966-6384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes347E00000XTransportation ServicesTransportation BrokerGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty