=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538327101
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AT HOMECARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2008
-----------------------------------------------------
Last Update Date | 05/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14123 WIMBLETON DR
-----------------------------------------------------
City | VICTORVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92395-4338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-880-2227
-----------------------------------------------------
Fax | 760-951-4973
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14123 WIMBLETON DR
-----------------------------------------------------
City | VICTORVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92395-4338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-880-2227
-----------------------------------------------------
Fax | 760-951-4973
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. PATRICIA SANTA MARIA TAMISIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 760-880-2227
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3747P1801X
-----------------------------------------------------
Taxonomy Name | Personal Care Attendant
-----------------------------------------------------
License Number | BSL07-01942
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------