Provider Demographics
NPI:1053641449
Name:AT HEART HOMECARE
Entity Type:Organization
Organization Name:AT HEART HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BITTLE-OBI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:704-909-7600
Mailing Address - Street 1:5501 EXECUTIVE CENTER DR
Mailing Address - Street 2:SUITE 234
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-8866
Mailing Address - Country:US
Mailing Address - Phone:704-909-7600
Mailing Address - Fax:704-831-8979
Practice Address - Street 1:5501 EXECUTIVE CENTER DR
Practice Address - Street 2:SUITE 234
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-8866
Practice Address - Country:US
Practice Address - Phone:704-909-7600
Practice Address - Fax:704-831-8979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care