Provider Demographics
NPI:1720024078
Name:A-1 HOME HEALTHCARE SERVICE CO
Entity Type:Organization
Organization Name:A-1 HOME HEALTHCARE SERVICE CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:C
Authorized Official - Last Name:LIND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-955-1654
Mailing Address - Street 1:118 S 25TH ST
Mailing Address - Street 2:P O BOX 1037
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-4312
Mailing Address - Country:US
Mailing Address - Phone:515-955-8500
Mailing Address - Fax:515-576-0243
Practice Address - Street 1:118 S 25TH ST
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4312
Practice Address - Country:US
Practice Address - Phone:515-955-8500
Practice Address - Fax:515-576-0243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA5855332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0128462Medicaid
IA0128447Medicaid
IA15979OtherBLUE CROSS PROVIDER NUMBE
IA0128447Medicaid