Provider Demographics
NPI:1538665211
Name:PROVIDER CARE AT HOME LLC
Entity Type:Organization
Organization Name:PROVIDER CARE AT HOME LLC
Other - Org Name:PROVIDER CARE AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-850-7592
Mailing Address - Street 1:1714 FORTVIEW RD STE 106E
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7659
Mailing Address - Country:US
Mailing Address - Phone:512-212-1402
Mailing Address - Fax:
Practice Address - Street 1:1714 FORTVIEW RD STE 106E
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7659
Practice Address - Country:US
Practice Address - Phone:512-212-1402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care