MEDICARE: AT HOME VA STAFFING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	385H00000X	Respite Care
2	374U00000X	Home Health Aide
3	251G00000X	Community Based Hospice Care Agency
4	251E00000X	Home Health Agency
5	251T00000X	PACE Provider Organization
6	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1023750924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AT HOME VA STAFFING LLC

Provider Business Mailing Address
First Line	:	1303 W VALENCIA DR # 319
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92833-4034
Country	:	US
Telephone Number	:	213-326-7452
Fax Number	:	714-860-8417

Provider Business Practice Location Address
First Line	:	1303 W VALENCIA DR
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92833-4034
Country	:	US
Telephone Number	:	213-326-7452
Fax Number	:	714-750-8417

Authorized Official
Title or Position	:	OWNER
Name	:	RUTH TIMA
Credential	:
Telephone Number	:	213-326-7452

Provider Enumeration Date	:	04/11/2022
Last Update Date	:	02/10/2026

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