Provider Demographics
NPI:1376685198
Name:AT HOME QUALITY CARE NON MEDICAL SVC.
Entity type:Organization
Organization Name:AT HOME QUALITY CARE NON MEDICAL SVC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-862-0025
Mailing Address - Street 1:PO BOX 731
Mailing Address - Street 2:111 N. ELKHART ST.
Mailing Address - City:WAKARUSA
Mailing Address - State:IN
Mailing Address - Zip Code:46573-0731
Mailing Address - Country:US
Mailing Address - Phone:574-862-0025
Mailing Address - Fax:574-862-0035
Practice Address - Street 1:111 N. ELKHART ST.
Practice Address - Street 2:
Practice Address - City:WAKARUSA
Practice Address - State:IN
Practice Address - Zip Code:46573-0731
Practice Address - Country:US
Practice Address - Phone:574-862-0025
Practice Address - Fax:574-862-0035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200981200AMedicaid