Provider Demographics
NPI:1538327101
Name:AT HOMECARE, INC.
Entity type:Organization
Organization Name:AT HOMECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:SANTA MARIA
Authorized Official - Last Name:TAMISIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-880-2227
Mailing Address - Street 1:14123 WIMBLETON DR
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-4338
Mailing Address - Country:US
Mailing Address - Phone:760-880-2227
Mailing Address - Fax:760-951-4973
Practice Address - Street 1:14123 WIMBLETON DR
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-4338
Practice Address - Country:US
Practice Address - Phone:760-880-2227
Practice Address - Fax:760-951-4973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABSL07-019423747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty