Provider Demographics
NPI:1205375854
Name:AT HEART HOME CARE
Entity Type:Organization
Organization Name:AT HEART HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:TRUJILLO
Authorized Official - Last Name:CORONADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-654-6921
Mailing Address - Street 1:14050 N 83RD AVE
Mailing Address - Street 2:SUITE 290
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5638
Mailing Address - Country:US
Mailing Address - Phone:619-654-6921
Mailing Address - Fax:623-561-1359
Practice Address - Street 1:14050 N 83RD AVE
Practice Address - Street 2:SUITE 290
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5638
Practice Address - Country:US
Practice Address - Phone:619-654-6921
Practice Address - Fax:623-561-1359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ619433251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health