Provider Demographics
NPI:1376082636
Name:AT HOME MEDICATION MANAGEMENT
Entity Type:Organization
Organization Name:AT HOME MEDICATION MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLIEN
Authorized Official - Middle Name:LINETTE
Authorized Official - Last Name:GOINS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:210-683-8951
Mailing Address - Street 1:4414 CENTERVIEW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1418
Mailing Address - Country:US
Mailing Address - Phone:210-683-8951
Mailing Address - Fax:210-963-6804
Practice Address - Street 1:4414 CENTERVIEW
Practice Address - Street 2:STE 165
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1418
Practice Address - Country:US
Practice Address - Phone:210-683-8951
Practice Address - Fax:210-963-6804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX843939251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health