MEDICARE: AT HOME BY CHOICE ASSISTED CARE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134336753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AT HOME BY CHOICE ASSISTED CARE, INC

Provider Business Mailing Address
First Line	:	2126 MCCULLOCH BLVD N
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-6742
Country	:	US
Telephone Number	:	928-855-0005
Fax Number	:	928-855-0075

Provider Business Practice Location Address
First Line	:	2126 MCCULLOCH BLVD N
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-6742
Country	:	US
Telephone Number	:	928-855-0005
Fax Number	:	928-855-0075

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CYNTHIA BIRNBAUM
Credential	:
Telephone Number	:	928-855-0005

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	08/22/2020

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