Provider Demographics
NPI:1164984597
Name:CARE AT HOME LLC
Entity Type:Organization
Organization Name:CARE AT HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAELONDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WOODARD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:219-229-1630
Mailing Address - Street 1:717 WASHINGTON PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-2056
Mailing Address - Country:US
Mailing Address - Phone:219-229-1630
Mailing Address - Fax:
Practice Address - Street 1:717 WASHINGTON PARK BLVD
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-2056
Practice Address - Country:US
Practice Address - Phone:219-229-1630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1386960599Medicaid