Provider Demographics
NPI:1396001301
Name:AT HOME HEALTHCARE OF VIRGINIA
Entity Type:Organization
Organization Name:AT HOME HEALTHCARE OF VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SPIVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-284-3705
Mailing Address - Street 1:9827 COGDILL RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-3376
Mailing Address - Country:US
Mailing Address - Phone:865-247-5645
Mailing Address - Fax:
Practice Address - Street 1:9827 COGDILL RD
Practice Address - Street 2:SUITE 6
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-3376
Practice Address - Country:US
Practice Address - Phone:865-247-5645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care