Provider Demographics
NPI:1578298964
Name:AT HOME MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:AT HOME MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCIO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:509-366-2942
Mailing Address - Street 1:5407 MAYS LN
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-7862
Mailing Address - Country:US
Mailing Address - Phone:509-366-2942
Mailing Address - Fax:
Practice Address - Street 1:5407 MAYS LN
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-7862
Practice Address - Country:US
Practice Address - Phone:509-366-2942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies