Provider Demographics
NPI:1770968554
Name:CONVENIENCE HOME HEALTH-AIDE
Entity type:Organization
Organization Name:CONVENIENCE HOME HEALTH-AIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:HUSSEIN
Authorized Official - Middle Name:MUHUMED
Authorized Official - Last Name:GUDAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-251-5174
Mailing Address - Street 1:809 N WEST AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-5740
Mailing Address - Country:US
Mailing Address - Phone:605-251-5174
Mailing Address - Fax:
Practice Address - Street 1:809 N WEST AVE APT 305
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-5740
Practice Address - Country:US
Practice Address - Phone:605-251-5174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home