Provider Demographics
NPI:1992575674
Name:AT HOME BY CHOICE HOME CARE LLC
Entity type:Organization
Organization Name:AT HOME BY CHOICE HOME CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN WAARDENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-765-4665
Mailing Address - Street 1:10971 FOUR SEASONS PL STE 128
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-8009
Mailing Address - Country:US
Mailing Address - Phone:219-386-5781
Mailing Address - Fax:
Practice Address - Street 1:10971 FOUR SEASONS PL STE 128
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8009
Practice Address - Country:US
Practice Address - Phone:219-386-5781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care