Provider Demographics
NPI:1689440299
Name:AT HOME TELEHEALTH
Entity Type:Organization
Organization Name:AT HOME TELEHEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:JENNETT
Authorized Official - Middle Name:
Authorized Official - Last Name:ATANGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-596-7113
Mailing Address - Street 1:611 IRONWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-3101
Mailing Address - Country:US
Mailing Address - Phone:630-596-7113
Mailing Address - Fax:
Practice Address - Street 1:611 IRONWOOD AVE
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-3101
Practice Address - Country:US
Practice Address - Phone:630-596-7113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care