Provider Demographics
NPI:1154962322
Name:AT HOME HEALTH, LLC
Entity type:Organization
Organization Name:AT HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COO
Authorized Official - Prefix:
Authorized Official - First Name:KAYLAN
Authorized Official - Middle Name:LYNNETTE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-590-5590
Mailing Address - Street 1:5050 POPLAR AVE STE 1715
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38157-1701
Mailing Address - Country:US
Mailing Address - Phone:901-590-5590
Mailing Address - Fax:
Practice Address - Street 1:5050 POPLAR AVE STE 1715
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38157-1701
Practice Address - Country:US
Practice Address - Phone:901-827-4522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1821649385OtherNPI