Provider Demographics
NPI:1750467379
Name:AT HOME- HOME CARE SERVICES, LLC.
Entity Type:Organization
Organization Name:AT HOME- HOME CARE SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-396-1573
Mailing Address - Street 1:6201 LA PAS TRL
Mailing Address - Street 2:SUITE 170
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-4887
Mailing Address - Country:US
Mailing Address - Phone:317-396-1573
Mailing Address - Fax:317-297-7895
Practice Address - Street 1:6201 LA PAS TRL
Practice Address - Street 2:SUITE 170
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-4887
Practice Address - Country:US
Practice Address - Phone:317-396-1573
Practice Address - Fax:317-297-7895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200853860AMedicaid
IN200853860AMedicaid
157590Medicare PIN