MEDICARE: AT HOME FAMILY SUPPORTS 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	8261582516	ME

General Provider Information

NPI Number	:	1255798070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AT HOME FAMILY SUPPORTS LLC

Provider Business Mailing Address
First Line	:	310 CAPE RD
Second Line	:
City	:	HOLLIS CENTER
State	:	ME
Zip	:	04042
Country	:	US
Telephone Number	:	207-205-6723
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 CAPE RD
Second Line	:
City	:	HOLLIS CENTER
State	:	ME
Zip	:	04042-3711
Country	:	US
Telephone Number	:	207-205-6723
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARGARET TARDIF
Credential	:
Telephone Number	:	855-642-2762

Provider Enumeration Date	:	01/25/2016
Last Update Date	:	01/25/2016

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