Provider Demographics
NPI:1326673286
Name:AT HOME - HOME CARE INC
Entity Type:Organization
Organization Name:AT HOME - HOME CARE INC
Other - Org Name:AT HOME - HOME CARE INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CASTILLE
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:337-789-1006
Mailing Address - Street 1:4400A AMBASSADOR CAFFERY PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6706
Mailing Address - Country:US
Mailing Address - Phone:337-393-6106
Mailing Address - Fax:337-464-9872
Practice Address - Street 1:4400A AMBASSADOR CAFFERY PKWY STE 228
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6706
Practice Address - Country:US
Practice Address - Phone:337-393-6106
Practice Address - Fax:337-464-9872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-11
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1205462017OtherNOW WAIVER
LA1326673286Medicaid
LA1326673286OtherNOW
LA1205462017Medicaid