Provider Demographics
NPI:1376509430
Name:ADVANCED TECHNOLOGIES IN HOME CARE, INC.
Entity Type:Organization
Organization Name:ADVANCED TECHNOLOGIES IN HOME CARE, INC.
Other - Org Name:AT HOME CARE, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSLOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-576-0087
Mailing Address - Street 1:8149 WALNUT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-4517
Mailing Address - Country:US
Mailing Address - Phone:804-359-3400
Mailing Address - Fax:804-359-3036
Practice Address - Street 1:8149 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-4517
Practice Address - Country:US
Practice Address - Phone:804-359-3400
Practice Address - Fax:804-359-3036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA497493251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004973381Medicaid
VA004973381Medicaid