Provider Demographics
NPI:1144787326
Name:AT HOME PHYSICIAN MANAGEMENT GROUP CO.
Entity Type:Organization
Organization Name:AT HOME PHYSICIAN MANAGEMENT GROUP CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-530-6017
Mailing Address - Street 1:27440 HOOVER RD STE C
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-7726
Mailing Address - Country:US
Mailing Address - Phone:586-530-6017
Mailing Address - Fax:
Practice Address - Street 1:27440 HOOVER RD STE C
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-7726
Practice Address - Country:US
Practice Address - Phone:586-530-6017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-25
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty