Provider Demographics
NPI:1841431228
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:EXCUTIVE 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:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15089305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization