Provider Demographics
NPI:1073077871
Name:ATHOME COMMUNITY SERVICES, LLC
Entity Type:Organization
Organization Name:ATHOME COMMUNITY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:512-413-6372
Mailing Address - Street 1:33 CYPRESS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1006
Mailing Address - Country:US
Mailing Address - Phone:512-336-0800
Mailing Address - Fax:512-336-0812
Practice Address - Street 1:3006 STATE HIGHWAY 159
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-4340
Practice Address - Country:US
Practice Address - Phone:512-336-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty