Provider Demographics
NPI:1265758452
Name:AT-HOME PERSONAL CARE SERVICES LLC.
Entity type:Organization
Organization Name:AT-HOME PERSONAL CARE SERVICES LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECT CARE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GUADALUPE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-589-0189
Mailing Address - Street 1:5305 MCNUTT RD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-5305
Mailing Address - Country:US
Mailing Address - Phone:575-589-0189
Mailing Address - Fax:575-589-0218
Practice Address - Street 1:5305 MCNUTT RD
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9653
Practice Address - Country:US
Practice Address - Phone:575-589-0189
Practice Address - Fax:575-589-0218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM64031284Medicaid