Provider Demographics
NPI:1700908274
Name:AT HOME HEALTH CARE SERVICE INC
Entity type:Organization
Organization Name:AT HOME HEALTH CARE SERVICE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:GURNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:435-529-3233
Mailing Address - Street 1:45 N 100 W
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:UT
Mailing Address - Zip Code:84654-1116
Mailing Address - Country:US
Mailing Address - Phone:435-529-3233
Mailing Address - Fax:435-529-3444
Practice Address - Street 1:45 N 100 W
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:UT
Practice Address - Zip Code:84654-1363
Practice Address - Country:US
Practice Address - Phone:435-529-3233
Practice Address - Fax:435-529-3444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2012-HOSPICE-49553251G00000X
UT2014-HHA-846251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT8705630002Medicaid
UT8705630002Medicaid
UT=========001Medicaid
UT=========007Medicaid
UT461530Medicare Oscar/Certification