Provider Demographics
NPI:1487166559
Name:KOOMA HOME HEALTH LLC
Entity type:Organization
Organization Name:KOOMA HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VEDWATTIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:KOOMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-875-3394
Mailing Address - Street 1:107 E MAIN ST STE 202B
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:PA
Mailing Address - Zip Code:18014-1519
Mailing Address - Country:US
Mailing Address - Phone:610-365-2383
Mailing Address - Fax:610-365-2383
Practice Address - Street 1:107 E MAIN ST STE 202B
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:PA
Practice Address - Zip Code:18014-1519
Practice Address - Country:US
Practice Address - Phone:610-365-2383
Practice Address - Fax:610-365-2383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-30
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health