Provider Demographics
NPI:1841534096
Name:AT HOME COMPANION CARE LLC
Entity type:Organization
Organization Name:AT HOME COMPANION CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:JOHNIKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-637-2201
Mailing Address - Street 1:339 N ROUTE 73 STE 6
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-9707
Mailing Address - Country:US
Mailing Address - Phone:856-637-2201
Mailing Address - Fax:609-270-5636
Practice Address - Street 1:339 N ROUTE 73 STE 6
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-9707
Practice Address - Country:US
Practice Address - Phone:856-637-2201
Practice Address - Fax:609-270-5636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-11
Last Update Date:2012-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0161400253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care