Provider Demographics
NPI:1720082290
Name:AT HOME REHAB, L.L.C.
Entity Type:Organization
Organization Name:AT HOME REHAB, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GUGLIELMI
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:267-241-4010
Mailing Address - Street 1:542 STREET RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3747
Mailing Address - Country:US
Mailing Address - Phone:215-230-4140
Mailing Address - Fax:215-230-4970
Practice Address - Street 1:542 STREET RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3747
Practice Address - Country:US
Practice Address - Phone:215-230-4140
Practice Address - Fax:215-230-4970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-12
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA77860501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA77860501OtherLICENSE NUMBER
PA397786Medicare ID - Type UnspecifiedPROVIDER NUMBER