Provider Demographics
NPI:1497072102
Name:AT HOME HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:AT HOME HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-523-9320
Mailing Address - Street 1:6525 E 82ND ST
Mailing Address - Street 2:SUITE 210-I
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1570
Mailing Address - Country:US
Mailing Address - Phone:317-523-9320
Mailing Address - Fax:317-288-5165
Practice Address - Street 1:6525 E 82ND ST
Practice Address - Street 2:SUITE 210-I
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-1570
Practice Address - Country:US
Practice Address - Phone:317-523-9320
Practice Address - Fax:317-288-5165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health