Provider Demographics
NPI:1639581531
Name:AT HOME MEMORY CARE, INC.
Entity Type:Organization
Organization Name:AT HOME MEMORY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MINDI
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLETT-TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-863-9999
Mailing Address - Street 1:4432 16 MILE RD NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49319-8426
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4432 16 MILE RD NE
Practice Address - Street 2:
Practice Address - City:CEDAR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49319-8426
Practice Address - Country:US
Practice Address - Phone:616-863-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703094913251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care