Healthcare Provider Details

I. General information

NPI: 1497589105
Provider Name (Legal Business Name): AT HOME HEALERS HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7840 SOUTHTOWN XING STE 104
FORT WAYNE IN
46816-2518
US

IV. Provider business mailing address

7840 SOUTHTOWN XING STE 104
FORT WAYNE IN
46816-2518
US

V. Phone/Fax

Practice location:
  • Phone: 260-702-0897
  • Fax:
Mailing address:
  • Phone: 260-702-0897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: SHANTELL SALTER-BOONE
Title or Position: CEO
Credential: OWNER
Phone: 260-702-0897