Provider Demographics
NPI:1225436330
Name:ATHOS HOME HEALTH
Entity Type:Organization
Organization Name:ATHOS HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:JR
Authorized Official - Credentials:RN
Authorized Official - Phone:817-741-7690
Mailing Address - Street 1:4936 CLIBURN DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6130
Mailing Address - Country:US
Mailing Address - Phone:817-741-7690
Mailing Address - Fax:817-741-7690
Practice Address - Street 1:4936 CLIBURN DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6130
Practice Address - Country:US
Practice Address - Phone:817-741-7690
Practice Address - Fax:817-741-7690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15234030251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health