Provider Demographics
NPI:1659425205
Name:ATC HOMECARE, INC.
Entity Type:Organization
Organization Name:ATC HOMECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HEDRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-831-1206
Mailing Address - Street 1:7309 SAN BENITO ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-3634
Mailing Address - Country:US
Mailing Address - Phone:505-831-1206
Mailing Address - Fax:505-833-0761
Practice Address - Street 1:7309 SAN BENITO ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-3634
Practice Address - Country:US
Practice Address - Phone:505-831-1206
Practice Address - Fax:505-833-0761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM94425272Medicaid