Healthcare Provider Details

I. General information

NPI: 1619759487
Provider Name (Legal Business Name): AT HOME HEALTH CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14509 JONES BRIDGE RD
BOWIE MD
20721-7246
US

IV. Provider business mailing address

14509 JONES BRIDGE RD
BOWIE MD
20721-7246
US

V. Phone/Fax

Practice location:
  • Phone: 301-523-0823
  • Fax:
Mailing address:
  • Phone: 301-523-0823
  • 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

VIII. Authorized Official

Name: MRS. GENEVIVE IBE
Title or Position: MANAGER
Credential: NURSE
Phone: 301-523-0823