Provider Demographics
NPI:1700582707
Name:KA BROTHERS HOME CARE SERVICE LLC
Entity Type:Organization
Organization Name:KA BROTHERS HOME CARE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MASKUR
Authorized Official - Middle Name:
Authorized Official - Last Name:KAWSAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-480-6558
Mailing Address - Street 1:42075 HANKS LN
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-3136
Mailing Address - Country:US
Mailing Address - Phone:586-480-6558
Mailing Address - Fax:
Practice Address - Street 1:42075 HANKS LN
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-3136
Practice Address - Country:US
Practice Address - Phone:586-480-6558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI9771354Medicaid