Provider Demographics
NPI:1730514555
Name:AT HOME CARE GROUP LLC
Entity type:Organization
Organization Name:AT HOME CARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-312-0051
Mailing Address - Street 1:205 SE WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1799
Mailing Address - Country:US
Mailing Address - Phone:541-312-0051
Mailing Address - Fax:541-312-0077
Practice Address - Street 1:205 SE WILSON AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1799
Practice Address - Country:US
Practice Address - Phone:541-312-0051
Practice Address - Fax:541-312-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15-2220251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health