Provider Demographics
NPI: | 1821236415 |
---|---|
Name: | AT HOME ASSISTED CARE LLC |
Entity Type: | Organization |
Organization Name: | AT HOME ASSISTED CARE LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE ADMINISTRATOR |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | JASON |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | STEWART |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 318-512-2304 |
Mailing Address - Street 1: | 1401 HUDSON LN |
Mailing Address - Street 2: | SUITE 206 |
Mailing Address - City: | MONROE |
Mailing Address - State: | LA |
Mailing Address - Zip Code: | 71201-6068 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 318-807-0905 |
Mailing Address - Fax: | 318-388-2163 |
Practice Address - Street 1: | 1401 HUDSON LN |
Practice Address - Street 2: | SUITE 206 |
Practice Address - City: | MONROE |
Practice Address - State: | LA |
Practice Address - Zip Code: | 71201-6068 |
Practice Address - Country: | US |
Practice Address - Phone: | 318-807-0905 |
Practice Address - Fax: | 318-388-2163 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-02-04 |
Last Update Date: | 2009-02-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
LA | 305R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 305R00000X | Managed Care Organizations | Preferred Provider Organization |