Provider Demographics
NPI:1487963542
Name:AT HOME SENIOR SERVICES, INC.
Entity type:Organization
Organization Name:AT HOME SENIOR SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-557-4663
Mailing Address - Street 1:PO BOX 1185
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526
Mailing Address - Country:US
Mailing Address - Phone:919-882-3680
Mailing Address - Fax:919-557-4673
Practice Address - Street 1:4000 BLUE RIDGE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4650
Practice Address - Country:US
Practice Address - Phone:919-882-3680
Practice Address - Fax:919-557-4673
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOMECHOICE HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-06
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3368251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health