Provider Demographics
NPI:1285043141
Name:ATHOME HEALTHCARE TEAM, LLC
Entity Type:Organization
Organization Name:ATHOME HEALTHCARE TEAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:JOCSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-255-4401
Mailing Address - Street 1:100 TOWER RD
Mailing Address - Street 2:SUITE 15 MAILBOX # 8
Mailing Address - City:AMERICAN CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:94503-9650
Mailing Address - Country:US
Mailing Address - Phone:707-255-4401
Mailing Address - Fax:
Practice Address - Street 1:100 TOWER RD
Practice Address - Street 2:SUITE 15 MAILBOX # 8
Practice Address - City:AMERICAN CANYON
Practice Address - State:CA
Practice Address - Zip Code:94503-9650
Practice Address - Country:US
Practice Address - Phone:707-255-4401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-05
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA201420210028251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health