Provider Demographics
NPI:1184788150
Name:AAA HOME HEALTH CARE AGENCY
Entity type:Organization
Organization Name:AAA HOME HEALTH CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOMUM-TIBAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-498-8435
Mailing Address - Street 1:23035 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-1627
Mailing Address - Country:US
Mailing Address - Phone:586-498-8435
Mailing Address - Fax:586-498-8425
Practice Address - Street 1:23035 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-1627
Practice Address - Country:US
Practice Address - Phone:586-498-8435
Practice Address - Fax:586-498-8425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X, 332B00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251E00000XAgenciesHome Health
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI35111OtherDME
MI4738381Medicaid
MI4738381Medicaid