Provider Demographics
NPI:1871352872
Name:BAHO RESIDENTIAL CARE LLC
Entity type:Organization
Organization Name:BAHO RESIDENTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:RWIGEMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-890-1186
Mailing Address - Street 1:715 10TH ST NE APT 201
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-3456
Mailing Address - Country:US
Mailing Address - Phone:704-890-1186
Mailing Address - Fax:
Practice Address - Street 1:715 10TH ST NE APT 201
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-3456
Practice Address - Country:US
Practice Address - Phone:704-890-1186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care