Provider Demographics
NPI:1376287631
Name:AT HOME SENIOR CARE OF AMERICA, LLC
Entity Type:Organization
Organization Name:AT HOME SENIOR CARE OF AMERICA, LLC
Other - Org Name:AT HOME SENIOR CARE OF AMERICA, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PEACE
Authorized Official - Middle Name:DZIGDORDI
Authorized Official - Last Name:DORMON
Authorized Official - Suffix:
Authorized Official - Credentials:HC PRACTITIONER
Authorized Official - Phone:336-508-3642
Mailing Address - Street 1:5695 NEW AVEDON DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-8399
Mailing Address - Country:US
Mailing Address - Phone:336-508-3642
Mailing Address - Fax:
Practice Address - Street 1:5695 NEW AVEDON DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-8399
Practice Address - Country:US
Practice Address - Phone:336-508-3642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-23
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care