Provider Demographics
NPI:1447679071
Name:AT HOME WELLNESS MANAGEMENT, LLC
Entity type:Organization
Organization Name:AT HOME WELLNESS MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WELLNESS DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORINA
Authorized Official - Middle Name:S
Authorized Official - Last Name:VENDETTO
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:860-574-5758
Mailing Address - Street 1:245 SHAW ST
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-5460
Mailing Address - Country:US
Mailing Address - Phone:860-574-5758
Mailing Address - Fax:860-574-9007
Practice Address - Street 1:245 SHAW ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-5460
Practice Address - Country:US
Practice Address - Phone:860-574-5758
Practice Address - Fax:860-574-9007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care