Provider Demographics
NPI:1750935094
Name:AIDEWELL HOME CARE, LLC.
Entity type:Organization
Organization Name:AIDEWELL HOME CARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSTAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALMIYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-516-7777
Mailing Address - Street 1:1335 W TABOR RD STE 306
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3041
Mailing Address - Country:US
Mailing Address - Phone:215-516-7777
Mailing Address - Fax:267-335-4611
Practice Address - Street 1:1335 W TABOR RD STE 306
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3041
Practice Address - Country:US
Practice Address - Phone:215-516-7777
Practice Address - Fax:267-335-4611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-25
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health