Provider Demographics
NPI:1023750924
Name:AT HOME VA STAFFING LLC
Entity type:Organization
Organization Name:AT HOME VA STAFFING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-326-7452
Mailing Address - Street 1:1630 SCHRADER BLVD
Mailing Address - Street 2:522
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-6349
Mailing Address - Country:US
Mailing Address - Phone:213-326-7452
Mailing Address - Fax:
Practice Address - Street 1:1630 SCHRADER BLVD APT 522
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-6349
Practice Address - Country:US
Practice Address - Phone:213-326-7452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-11
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community BasedGroup - Single Specialty
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider OrganizationGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty