Provider Demographics
NPI:1740584820
Name:AT HOME ASSISTED LIVING SERVICES, L.L.C.
Entity Type:Organization
Organization Name:AT HOME ASSISTED LIVING SERVICES, L.L.C.
Other - Org Name:AT HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-621-2992
Mailing Address - Street 1:1216 MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-1715
Mailing Address - Country:US
Mailing Address - Phone:765-621-2992
Mailing Address - Fax:765-274-4555
Practice Address - Street 1:1216 MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-1715
Practice Address - Country:US
Practice Address - Phone:765-621-2992
Practice Address - Fax:765-274-4555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10-012292-1253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care