MEDICARE: AT HOME CARE L.L.C.

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	004895	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	HH8973	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225034390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AT HOME CARE L.L.C.

Provider Business Mailing Address
First Line	:	PO BOX 1373
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76307-1373
Country	:	US
Telephone Number	:	940-766-4663
Fax Number	:	940-766-2236

Provider Business Practice Location Address
First Line	:	1109 BROOK AVE
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-5008
Country	:	US
Telephone Number	:	940-766-4663
Fax Number	:	940-766-2236

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	CHARLENE E CLUTE
Credential	:	RN
Telephone Number	:	940-766-4663

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	08/22/2020

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Directions to “AT HOME CARE L.L.C. ” Practice Location

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