Provider Demographics
NPI:1376375535
Name:NURSE AT HOME LLC
Entity type:Organization
Organization Name:NURSE AT HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SONDRA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:GROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-236-9279
Mailing Address - Street 1:13300 N 88TH AVE APT 2169
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-3845
Mailing Address - Country:US
Mailing Address - Phone:317-236-9279
Mailing Address - Fax:
Practice Address - Street 1:13300 N 88TH AVE APT 2169
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-3845
Practice Address - Country:US
Practice Address - Phone:317-236-9279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-16
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care