Provider Demographics
NPI:1144332750
Name:AT HOME HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:AT HOME HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-242-4720
Mailing Address - Street 1:8898 COMMERCE RD STE 2B
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-4485
Mailing Address - Country:US
Mailing Address - Phone:248-242-4720
Mailing Address - Fax:248-242-4721
Practice Address - Street 1:8898 COMMERCE RD STE 2B
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-4485
Practice Address - Country:US
Practice Address - Phone:248-242-4720
Practice Address - Fax:248-242-4721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23-7618Medicare Oscar/Certification