Provider Demographics
NPI:1104856111
Name:EDNA M AUGUSTINE
Entity Type:Organization
Organization Name:EDNA M AUGUSTINE
Other - Org Name:AT-HOME CARE SYSTEMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:AUGUSTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-582-9819
Mailing Address - Street 1:6035 UNIVERSITY AVE STE 32
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-6343
Mailing Address - Country:US
Mailing Address - Phone:619-582-9819
Mailing Address - Fax:619-582-9820
Practice Address - Street 1:6035 UNIVERSITY AVE STE 32
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-6343
Practice Address - Country:US
Practice Address - Phone:619-582-9819
Practice Address - Fax:619-582-9820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0793850001Medicare NSC