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General NPI Number Information
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NPI Number | 1669792370
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Entity Type | Organization
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Legal Business Name | AT HOME FOR YOU
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Dates
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Enumeration Date | 06/03/2010
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Last Update Date | 06/03/2010
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Provider Practice Location Address
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Address Line | 16462 SHAMROCK DR
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City | MISHAWAKA
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State | IN
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Zip | 46544-6491
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Country | US
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Telephone | 574-855-1536
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Fax | 574-855-1099
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Provider Business Mailing Address
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Address Line | 16462 SHAMROCK DR
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City | MISHAWAKA
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State | IN
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Zip | 46544-6491
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Country | US
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Telephone | 574-855-1536
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Fax | 574-855-1099
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. JIMMY DALE GRIMES
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Credential | ADMINISTRATOR
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Telephone | 574-855-1536
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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 | 10-012231-1
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License Number State | IN
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