Provider Demographics
NPI:1962110080
Name:AT HOME HEALTHCARE AGENCY LLC
Entity type:Organization
Organization Name:AT HOME HEALTHCARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENY/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ELVIS
Authorized Official - Middle Name:ASONGANYI
Authorized Official - Last Name:AZAP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-551-2473
Mailing Address - Street 1:4156 BEVERLY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-1649
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4156 BEVERLY HILLS DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-1649
Practice Address - Country:US
Practice Address - Phone:216-551-2473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health