Provider Demographics
NPI:1821411836
Name:AT HOME CAREGIVERS
Entity Type:Organization
Organization Name:AT HOME CAREGIVERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:PUCKETT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:540-206-3364
Mailing Address - Street 1:90 TOWN CENTER ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DALEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24083-3741
Mailing Address - Country:US
Mailing Address - Phone:540-206-3364
Mailing Address - Fax:540-206-3367
Practice Address - Street 1:90 TOWN CENTER ST
Practice Address - Street 2:SUITE 201
Practice Address - City:DALEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24083-3741
Practice Address - Country:US
Practice Address - Phone:540-206-3364
Practice Address - Fax:540-206-3367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-141036251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAHCO-141036OtherVIRGINIA HOME CARE ORGANIZATION LICENSE