Provider Demographics
NPI:1487885364
Name:AT HOME HEALTHCARE LLC
Entity type:Organization
Organization Name:AT HOME HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:BESSIE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-201-6200
Mailing Address - Street 1:468 S INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE A 102
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1158
Mailing Address - Country:US
Mailing Address - Phone:757-201-6200
Mailing Address - Fax:757-222-1794
Practice Address - Street 1:468 S INDEPENDENCE BLVD
Practice Address - Street 2:SUITE A 102
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1158
Practice Address - Country:US
Practice Address - Phone:757-201-6200
Practice Address - Fax:757-222-1794
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HPR MEDICAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-27
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHC10405253Z00000X
VAHC-10405332B00000X, 343900000X
VAHCO-15405253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)