Healthcare Provider Details

I. General information

NPI: 1255798070
Provider Name (Legal Business Name): AT HOME FAMILY SUPPORTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 CAPE RD
HOLLIS CENTER ME
04042-3711
US

IV. Provider business mailing address

310 CAPE RD
HOLLIS CENTER ME
04042
US

V. Phone/Fax

Practice location:
  • Phone: 207-205-6723
  • Fax:
Mailing address:
  • Phone: 207-205-6723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number8261582516
License Number StateME

VIII. Authorized Official

Name: MARGARET TARDIF
Title or Position: PRESIDENT
Credential:
Phone: 855-642-2762