Healthcare Provider Details

I. General information

NPI: 1588201826
Provider Name (Legal Business Name): AT HOME QUALITY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 WEST GOVERNOR ROAD
HERSHEY PA
17033-2219
US

IV. Provider business mailing address

611 ROUTE 46 WEST, SUITE 200
HASBROUCK HEIGHTS NJ
07604-1307
US

V. Phone/Fax

Practice location:
  • Phone: 570-587-4700
  • Fax: 201-621-4325
Mailing address:
  • Phone: 551-223-1941
  • Fax: 201-621-4325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1024949780002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MRS. TRACIE COLLINS-BURNS
Title or Position: AR BILLING MANAGER/CONTRACTS
Credential:
Phone: 551-223-1941