=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659330017
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AT HOME CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2006
-----------------------------------------------------
Last Update Date | 04/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1519 UNIVERSITY DR
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61920-3203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-345-4003
-----------------------------------------------------
Fax | 217-345-4044
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1519 UNIVERSITY DR
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61920-3203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-345-4003
-----------------------------------------------------
Fax | 217-345-4044
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MELISSA HIGELMIRE
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 217-345-4003
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 1010099
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------