Provider Demographics
NPI:1457075681
Name:SOFIA HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:SOFIA HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-600-3757
Mailing Address - Street 1:3702 RUPP DR STE 4
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-4526
Mailing Address - Country:US
Mailing Address - Phone:260-387-7808
Mailing Address - Fax:
Practice Address - Street 1:3702 RUPP DR STE 4
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-4526
Practice Address - Country:US
Practice Address - Phone:260-387-7808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty