Provider Demographics
NPI:1003238098
Name:AT HOME PHYSICIANS SERVICES, LLC
Entity Type:Organization
Organization Name:AT HOME PHYSICIANS SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFONSO
Authorized Official - Middle Name:D
Authorized Official - Last Name:ENRIQUEZ
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:623-755-3590
Mailing Address - Street 1:4957 I EAST HULL ST.,
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077
Mailing Address - Country:US
Mailing Address - Phone:623-755-3590
Mailing Address - Fax:773-561-3583
Practice Address - Street 1:4957 I EAST HULL ST.,
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077
Practice Address - Country:US
Practice Address - Phone:623-755-3590
Practice Address - Fax:773-561-3583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty