Provider Demographics
NPI:1790002806
Name:AT YOUR HOME FAMILYCARE
Entity Type:Organization
Organization Name:AT YOUR HOME FAMILYCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS-TATE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:858-625-0406
Mailing Address - Street 1:6540 LUSK BLVD
Mailing Address - Street 2:SUITE C-266
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2767
Mailing Address - Country:US
Mailing Address - Phone:858-625-0406
Mailing Address - Fax:
Practice Address - Street 1:6540 LUSK BLVD
Practice Address - Street 2:STE C-266
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2767
Practice Address - Country:US
Practice Address - Phone:858-625-0406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty