Provider Demographics
NPI:1669792370
Name:AT HOME FOR YOU
Entity type:Organization
Organization Name:AT HOME FOR YOU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:574-855-1536
Mailing Address - Street 1:16462 SHAMROCK DR
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-6491
Mailing Address - Country:US
Mailing Address - Phone:574-855-1536
Mailing Address - Fax:574-855-1099
Practice Address - Street 1:16462 SHAMROCK DR
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-6491
Practice Address - Country:US
Practice Address - Phone:574-855-1536
Practice Address - Fax:574-855-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10-012231-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health