Provider Demographics
NPI:1609315431
Name:AT HOME CARE AND HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:AT HOME CARE AND HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:TEED
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:435-256-0867
Mailing Address - Street 1:639 S 315 E
Mailing Address - Street 2:
Mailing Address - City:IVINS
Mailing Address - State:UT
Mailing Address - Zip Code:84738-5054
Mailing Address - Country:US
Mailing Address - Phone:435-256-0867
Mailing Address - Fax:435-652-3675
Practice Address - Street 1:639 S 315 E
Practice Address - Street 2:
Practice Address - City:IVINS
Practice Address - State:UT
Practice Address - Zip Code:84738-5054
Practice Address - Country:US
Practice Address - Phone:435-256-0867
Practice Address - Fax:435-652-3675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2016-PCA-UT000780251T00000X, 347C00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No347C00000XTransportation ServicesPrivate Vehicle
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1700331162Medicaid
UT1700331162OtherMOLINA
UT1700331162OtherBLUE CROSS/BLUE SHIELD
UT1700331162OtherSELECT HEALTH
UT1700331162OtherMOLINA