Provider Demographics
NPI:1568686053
Name:AT-HOME SUPPORT CARE, INC
Entity Type:Organization
Organization Name:AT-HOME SUPPORT CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HURLOCKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:620-341-9350
Mailing Address - Street 1:1420 C OF E DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-2599
Mailing Address - Country:US
Mailing Address - Phone:620-341-9350
Mailing Address - Fax:620-341-9375
Practice Address - Street 1:1420 C OF E DR
Practice Address - Street 2:SUITE 300
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-2599
Practice Address - Country:US
Practice Address - Phone:620-341-9350
Practice Address - Fax:620-341-9375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA056013251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health