Provider Demographics
NPI:1417398520
Name:AT HOME CARE, INC.
Entity Type:Organization
Organization Name:AT HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:JEANETTE
Authorized Official - Last Name:FELTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:601-437-3524
Mailing Address - Street 1:306 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:PORT GIBSON
Mailing Address - State:MS
Mailing Address - Zip Code:39150-2108
Mailing Address - Country:US
Mailing Address - Phone:601-437-3524
Mailing Address - Fax:601-437-3570
Practice Address - Street 1:5015 I 55 N
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-4306
Practice Address - Country:US
Practice Address - Phone:601-362-1701
Practice Address - Fax:601-362-0405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS00770582311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1871785527Medicaid
MS1437353752Medicaid
MS1871785527Medicaid