Provider Demographics
NPI:1275007866
Name:AT HOME PERSONAL CARE LLC
Entity Type:Organization
Organization Name:AT HOME PERSONAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JONG
Authorized Official - Middle Name:
Authorized Official - Last Name:XIONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-704-9114
Mailing Address - Street 1:W175N11163 STONEWOOD DR STE 290
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-6500
Mailing Address - Country:US
Mailing Address - Phone:262-245-3301
Mailing Address - Fax:262-245-3302
Practice Address - Street 1:W175N11163 STONEWOOD DR STE 290
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-6500
Practice Address - Country:US
Practice Address - Phone:262-245-3301
Practice Address - Fax:262-245-3302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care