Provider Demographics
NPI:1538575949
Name:AT HOME PERSONAL CARE
Entity type:Organization
Organization Name:AT HOME PERSONAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SLATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-596-9500
Mailing Address - Street 1:PO BOX 645
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:VA
Mailing Address - Zip Code:24609-0645
Mailing Address - Country:US
Mailing Address - Phone:276-596-9500
Mailing Address - Fax:276-596-9501
Practice Address - Street 1:2032 CEDAR VALLEY DR
Practice Address - Street 2:SUITE1
Practice Address - City:CEDAR BLUFF
Practice Address - State:VA
Practice Address - Zip Code:24609
Practice Address - Country:US
Practice Address - Phone:276-596-9500
Practice Address - Fax:276-596-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-07360253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care