Provider Demographics
NPI:1811568611
Name:AXT HOME CARE LLC
Entity Type:Organization
Organization Name:AXT HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-240-1992
Mailing Address - Street 1:36 E LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2323
Mailing Address - Country:US
Mailing Address - Phone:937-240-1992
Mailing Address - Fax:
Practice Address - Street 1:36 E LOCUST ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2323
Practice Address - Country:US
Practice Address - Phone:937-240-1992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AXT HOME CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care