MEDICARE: AT HOME SENIOR SERVICES

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	253Z00000X	In Home Supportive Care Agency	HC4684	NC

General Provider Information

NPI Number	:	1992108203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AT HOME SENIOR SERVICES

Provider Business Mailing Address
First Line	:	1000 N MAIN ST
Second Line	:	SUITE 219
City	:	FUQUAY VARINA
State	:	NC
Zip	:	27526-2056
Country	:	US
Telephone Number	:	919-606-1739
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 N MAIN ST
Second Line	:	SUITE 219
City	:	FUQUAY VARINA
State	:	NC
Zip	:	27526-2056
Country	:	US
Telephone Number	:	919-606-1739
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PHILLIP MORRIS
Credential	:
Telephone Number	:	919-606-1739

Provider Enumeration Date	:	09/30/2014
Last Update Date	:	09/30/2014

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