Provider Demographics
NPI:1942535364
Name:AT HOME CARE, INC
Entity Type:Organization
Organization Name:AT HOME CARE, INC
Other - Org Name:AHC,INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:O
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:CLINICIAN
Authorized Official - Phone:405-843-2333
Mailing Address - Street 1:PO BOX 5961
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-5961
Mailing Address - Country:US
Mailing Address - Phone:405-843-2333
Mailing Address - Fax:405-843-2344
Practice Address - Street 1:1901 N CLASSEN BLVD STE 108
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-6011
Practice Address - Country:US
Practice Address - Phone:405-843-2333
Practice Address - Fax:405-843-2344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-04
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKCSS0009253Z00000X
385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKCSS0009OtherHOME CARE -LICENSED HOME MAKER/SITTER COMPANION CARE
OKCSS0009OtherHOME CARE -LICENSED LIVE-IN CARE/24/7/RESPITE/PCA