Provider Demographics
NPI:1225034390
Name:AT HOME CARE L.L.C.
Entity Type:Organization
Organization Name:AT HOME CARE L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:E
Authorized Official - Last Name:CLUTE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:940-766-4663
Mailing Address - Street 1:PO BOX 1373
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76307-1373
Mailing Address - Country:US
Mailing Address - Phone:940-766-4663
Mailing Address - Fax:940-766-2236
Practice Address - Street 1:1109 BROOK AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5008
Practice Address - Country:US
Practice Address - Phone:940-766-4663
Practice Address - Fax:940-766-2236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX004895251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000854200Medicaid
TXHH8973OtherBCBS
TX000023300Medicaid