MEDICARE: AT HOME REHAB, 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	77860501	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	77860501	OTHER	PA	LICENSE NUMBER

General Provider Information

NPI Number	:	1720082290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AT HOME REHAB, L.L.C.

Provider Business Mailing Address
First Line	:	542 STREET RD
Second Line	:
City	:	SOUTHAMPTON
State	:	PA
Zip	:	18966-3747
Country	:	US
Telephone Number	:	215-230-4140
Fax Number	:	215-230-4970

Provider Business Practice Location Address
First Line	:	542 STREET RD
Second Line	:
City	:	SOUTHAMPTON
State	:	PA
Zip	:	18966-3747
Country	:	US
Telephone Number	:	215-230-4140
Fax Number	:	215-230-4970

Authorized Official
Title or Position	:	CEO
Name	:	MS. JENNIFER ANN GUGLIELMI
Credential	:	M.S.P.T.
Telephone Number	:	267-241-4010

Provider Enumeration Date	:	06/12/2005
Last Update Date	:	06/17/2016

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