Provider Demographics
NPI:1659835957
Name:AT MY PLACE, MY HOME LLC
Entity Type:Organization
Organization Name:AT MY PLACE, MY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOREE
Authorized Official - Middle Name:
Authorized Official - Last Name:IGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-848-2982
Mailing Address - Street 1:3050 FIVE FORKS TRICKUM RD SW STE D
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-5067
Mailing Address - Country:US
Mailing Address - Phone:470-848-2982
Mailing Address - Fax:
Practice Address - Street 1:483 GLENNS FARM LN
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-4921
Practice Address - Country:US
Practice Address - Phone:470-848-2982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-31
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health