Provider Demographics
NPI:1417932310
Name:AT HOME HEALTHCARE OF FT. PIERCE INC.
Entity Type:Organization
Organization Name:AT HOME HEALTHCARE OF FT. PIERCE INC.
Other - Org Name:CARTER HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-947-7700
Mailing Address - Street 1:3105 S MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73119-1022
Mailing Address - Country:US
Mailing Address - Phone:405-947-7700
Mailing Address - Fax:405-947-7300
Practice Address - Street 1:1080 E INDIANTOWN RD
Practice Address - Street 2:SUITE 205
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-5100
Practice Address - Country:US
Practice Address - Phone:772-770-1100
Practice Address - Fax:772-770-9164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA299992157251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108212Medicare ID - Type UnspecifiedPROVIDER NUMBER