Provider Demographics
NPI:1417522210
Name:AT HOME WITH VAN DYK, LLC
Entity type:Organization
Organization Name:AT HOME WITH VAN DYK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELCHIONDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-689-7991
Mailing Address - Street 1:644 GOFFLE RD
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-3452
Mailing Address - Country:US
Mailing Address - Phone:973-238-4339
Mailing Address - Fax:
Practice Address - Street 1:288 S VAN DIEN AVE # D
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-5226
Practice Address - Country:US
Practice Address - Phone:201-444-4257
Practice Address - Fax:201-689-7980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health