Provider Demographics
NPI:1437318847
Name:AT YOUR DOOR ELDERCARE, LLC
Entity Type:Organization
Organization Name:AT YOUR DOOR ELDERCARE, LLC
Other - Org Name:RIGHT AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-878-2885
Mailing Address - Street 1:17035 N 67TH AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-4511
Mailing Address - Country:US
Mailing Address - Phone:623-878-2885
Mailing Address - Fax:623-878-6512
Practice Address - Street 1:17035 N 67TH AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-4511
Practice Address - Country:US
Practice Address - Phone:623-878-2885
Practice Address - Fax:623-878-6512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ338973Medicaid
AZ093834OtherSCAN LONG TERM HEALTH PLAN