Provider Demographics
NPI:1659330017
Name:AT HOME CARE, INC.
Entity Type:Organization
Organization Name:AT HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGELMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:217-345-4003
Mailing Address - Street 1:1519 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-3203
Mailing Address - Country:US
Mailing Address - Phone:217-345-4003
Mailing Address - Fax:217-345-4044
Practice Address - Street 1:1519 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-3203
Practice Address - Country:US
Practice Address - Phone:217-345-4003
Practice Address - Fax:217-345-4044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010099251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid