Healthcare Provider Details

I. General information

NPI: 1023750924
Provider Name (Legal Business Name): AT HOME VA STAFFING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 W VALENCIA DR
FULLERTON CA
92833-4034
US

IV. Provider business mailing address

1303 W VALENCIA DR # 319
FULLERTON CA
92833-4034
US

V. Phone/Fax

Practice location:
  • Phone: 213-326-7452
  • Fax: 714-750-8417
Mailing address:
  • Phone: 213-326-7452
  • Fax: 714-860-8417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: RUTH TIMA
Title or Position: OWNER
Credential:
Phone: 213-326-7452