Provider Demographics
NPI:1215203633
Name:AT HOME HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:AT HOME HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALLING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CUSTARDO
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:630-362-4469
Mailing Address - Street 1:9435 BORMET DR
Mailing Address - Street 2:UNIT 1
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8363
Mailing Address - Country:US
Mailing Address - Phone:708-478-6565
Mailing Address - Fax:708-478-5458
Practice Address - Street 1:9435 BORMET DR
Practice Address - Street 2:UNIT 1
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8363
Practice Address - Country:US
Practice Address - Phone:708-478-6565
Practice Address - Fax:708-478-5458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILAPPLIED FOR251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health