Provider Demographics
NPI:1235454521
Name:AT HOME CAREGIVERS, LLC
Entity Type:Organization
Organization Name:AT HOME CAREGIVERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FLORDELIZA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ANTOLIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-240-3800
Mailing Address - Street 1:3017 W CHARLESTON BLVD STE 12
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1927
Mailing Address - Country:US
Mailing Address - Phone:702-240-3800
Mailing Address - Fax:702-240-3001
Practice Address - Street 1:3017 W CHARLESTON BLVD STE 12
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1927
Practice Address - Country:US
Practice Address - Phone:702-240-3800
Practice Address - Fax:702-240-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5267PCS253Z00000X
372500000X, 3747A0650X, 3747P1801X, 376J00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVAPI#9005041320Medicaid
NV100504937Medicaid
NVAPI#9005056484Medicaid
NVAPI#9005054299Medicaid