Provider Demographics
NPI:1457948820
Name:AA HOME HEALTH ASSISTANCE, LLC
Entity Type:Organization
Organization Name:AA HOME HEALTH ASSISTANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSAH
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-717-1982
Mailing Address - Street 1:6141 PIEDMONT RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-4683
Mailing Address - Country:US
Mailing Address - Phone:919-717-1982
Mailing Address - Fax:
Practice Address - Street 1:6141 PIEDMONT RIDGE CIR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-4683
Practice Address - Country:US
Practice Address - Phone:919-717-1982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-30
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC85437776Medicaid