Provider Demographics
NPI:1407365299
Name:INDEPENDENCE AT HOME LLC.
Entity Type:Organization
Organization Name:INDEPENDENCE AT HOME LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIANNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DUKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-616-3766
Mailing Address - Street 1:422 MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-1824
Mailing Address - Country:US
Mailing Address - Phone:582-400-3028
Mailing Address - Fax:
Practice Address - Street 1:422 MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-1824
Practice Address - Country:US
Practice Address - Phone:582-400-3028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-25
Last Update Date:2023-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care