Provider Demographics
NPI:1912139288
Name:AT HOME REHAB, LLC
Entity type:Organization
Organization Name:AT HOME REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:800-880-9715
Mailing Address - Street 1:5088 CORPORATE EXCHANGE BLVD SE
Mailing Address - Street 2:STE. 350
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-5517
Mailing Address - Country:US
Mailing Address - Phone:800-880-9715
Mailing Address - Fax:800-880-9715
Practice Address - Street 1:5088 CORPORATE EXCHANGE BLVD SE
Practice Address - Street 2:STE. 350
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-5517
Practice Address - Country:US
Practice Address - Phone:800-880-9715
Practice Address - Fax:800-880-9715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-19
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI239184Medicare Oscar/Certification