Healthcare Provider Details

I. General information

NPI: 1477038982
Provider Name (Legal Business Name): ATHOME HEALTHCARE TEAM - EAST BAY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 OLYMPIC BLVD STE 201
WALNUT CREEK CA
94596-5026
US

IV. Provider business mailing address

1875 OLYMPIC BLVD STE 201
WALNUT CREEK CA
94596-5026
US

V. Phone/Fax

Practice location:
  • Phone: 925-448-2177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JAYCEE TAN
Title or Position: VICE PRESIDENT
Credential: PTA
Phone: 925-357-0919