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General NPI Number Information
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NPI Number | 1821411836
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Entity Type | Organization
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Legal Business Name | AT HOME CAREGIVERS
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Dates
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Enumeration Date | 01/27/2014
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Last Update Date | 01/27/2014
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Provider Practice Location Address
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Address Line | 90 TOWN CENTER ST SUITE 201
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City | DALEVILLE
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State | VA
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Zip | 24083-3741
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Country | US
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Telephone | 540-206-3364
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Fax | 540-206-3367
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Provider Business Mailing Address
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Address Line | 90 TOWN CENTER ST SUITE 201
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City | DALEVILLE
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State | VA
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Zip | 24083-3741
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Country | US
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Telephone | 540-206-3364
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Fax | 540-206-3367
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Authorized Official
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Title or Position | OWNER
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Name | GEORGE RAYMOND PUCKETT JR.
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Credential |
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Telephone | 540-206-3364
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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 | HCO-141036
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License Number State | VA
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