Provider Demographics
NPI:1881433811
Name:AIDLIFE HOME CARE, LLC
Entity type:Organization
Organization Name:AIDLIFE HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LIGGAYU
Authorized Official - Suffix:
Authorized Official - Credentials:BSN-RN, PHN, PCCN
Authorized Official - Phone:707-515-8234
Mailing Address - Street 1:PO BOX 32663
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95152-2663
Mailing Address - Country:US
Mailing Address - Phone:707-515-8234
Mailing Address - Fax:
Practice Address - Street 1:700 E ST STE 102-3
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2762
Practice Address - Country:US
Practice Address - Phone:707-641-6006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA484700029OtherCA HOME CARE SERVICES BRANCH