Provider Demographics
NPI:1457618704
Name:AT YOUR HOME PRIMARY CARE, INC.
Entity type:Organization
Organization Name:AT YOUR HOME PRIMARY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:POPPE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:425-299-2170
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98291-0126
Mailing Address - Country:US
Mailing Address - Phone:425-299-2170
Mailing Address - Fax:
Practice Address - Street 1:3922 113TH AVE SE
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-5589
Practice Address - Country:US
Practice Address - Phone:425-299-2170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care