MEDICARE: AT HOME HEALTHCARE OF FT. PIERCE INC.

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	HHA299992157	FL

General Provider Information

NPI Number	:	1417932310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AT HOME HEALTHCARE OF FT. PIERCE INC.

Provider Business Mailing Address
First Line	:	3105 S MERIDIAN AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73119-1022
Country	:	US
Telephone Number	:	405-947-7700
Fax Number	:	405-947-7300

Provider Business Practice Location Address
First Line	:	1080 E INDIANTOWN RD
Second Line	:	SUITE 205
City	:	JUPITER
State	:	FL
Zip	:	33477-5100
Country	:	US
Telephone Number	:	772-770-1100
Fax Number	:	772-770-9164

Authorized Official
Title or Position	:	BILLING SUPERVISOR
Name	:	ROBERT LEE PETERS
Credential	:
Telephone Number	:	405-947-7700

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	05/23/2023

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