Provider Demographics
NPI:1710198122
Name:AT HOME RESIDENTIAL SVS INC.
Entity Type:Organization
Organization Name:AT HOME RESIDENTIAL SVS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-584-3969
Mailing Address - Street 1:214 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:HIGGINSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64037
Mailing Address - Country:US
Mailing Address - Phone:660-584-3969
Mailing Address - Fax:660-584-5512
Practice Address - Street 1:214 E 13TH ST
Practice Address - Street 2:
Practice Address - City:HIGGINSVILLE
Practice Address - State:MO
Practice Address - Zip Code:64037
Practice Address - Country:US
Practice Address - Phone:660-584-3969
Practice Address - Fax:660-584-5512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO856277314320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities