Provider Demographics
NPI:1619551264
Name:NURSE AT HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:NURSE AT HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-701-4823
Mailing Address - Street 1:1415 LA CASITA ST
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-7428
Mailing Address - Country:US
Mailing Address - Phone:321-701-4823
Mailing Address - Fax:
Practice Address - Street 1:1415 LA CASITA ST
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-7428
Practice Address - Country:US
Practice Address - Phone:321-701-4823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health