Provider Demographics
NPI:1659816247
Name:MY DOC AT HOME, LLC
Entity Type:Organization
Organization Name:MY DOC AT HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:ALANE
Authorized Official - Last Name:CHAMPINE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:623-980-6670
Mailing Address - Street 1:8633 W SHAW BUTTE DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-8186
Mailing Address - Country:US
Mailing Address - Phone:623-980-6670
Mailing Address - Fax:
Practice Address - Street 1:8633 W SHAW BUTTE DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-8186
Practice Address - Country:US
Practice Address - Phone:623-980-6670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN161499163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty