Provider Demographics
NPI:1912150608
Name:AT HOME NURSING
Entity Type:Organization
Organization Name:AT HOME NURSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:DVORAK
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:605-224-2930
Mailing Address - Street 1:1102 S CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-4456
Mailing Address - Country:US
Mailing Address - Phone:605-224-2930
Mailing Address - Fax:605-224-0548
Practice Address - Street 1:1102 S CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-4456
Practice Address - Country:US
Practice Address - Phone:605-224-2930
Practice Address - Fax:605-224-0548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health