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General NPI Number Information
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NPI Number | 1225034390
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Entity Type | Organization
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Legal Business Name | AT HOME CARE L.L.C.
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Dates
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Enumeration Date | 06/23/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1109 BROOK AVE
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City | WICHITA FALLS
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State | TX
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Zip | 76301-5008
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Country | US
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Telephone | 940-766-4663
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Fax | 940-766-2236
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Provider Business Mailing Address
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Address Line | PO BOX 1373
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City | WICHITA FALLS
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State | TX
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Zip | 76307-1373
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Country | US
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Telephone | 940-766-4663
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Fax | 940-766-2236
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | CHARLENE E CLUTE
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Credential | RN
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Telephone | 940-766-4663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 004895
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License Number State | TX
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