MEDICARE: AT MARTIN'S HOMECARE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	200902800988	OH

General Provider Information

NPI Number	:	1184863995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AT MARTIN'S HOMECARE, LLC

Provider Business Mailing Address
First Line	:	4770 INDIANOLA AVE
Second Line	:	SUITE 200
City	:	COLUMBUS
State	:	OH
Zip	:	43214-1862
Country	:	US
Telephone Number	:	614-556-3391
Fax Number	:	614-781-6525

Provider Business Practice Location Address
First Line	:	4770 INDIANOLA AVE
Second Line	:	SUITE 200
City	:	COLUMBUS
State	:	OH
Zip	:	43214-1862
Country	:	US
Telephone Number	:	614-556-3391
Fax Number	:	614-781-6525

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MARTIN ATTOBRA AMALAMAN
Credential	:
Telephone Number	:	614-556-3391

Provider Enumeration Date	:	02/18/2009
Last Update Date	:	02/28/2011

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