Provider Demographics
NPI:1487305512
Name:AHAVA HOME CARE
Entity type:Organization
Organization Name:AHAVA HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:502-735-8879
Mailing Address - Street 1:113 BLACKBERRY RDG
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9648
Mailing Address - Country:US
Mailing Address - Phone:859-351-6642
Mailing Address - Fax:
Practice Address - Street 1:113 BLACKBERRY RDG
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9648
Practice Address - Country:US
Practice Address - Phone:859-351-6642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-11
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care