Organization
AHI SKIN REJUVENATION CENTER
Active
Parent organization
AT HOME INC
Other names
At Home Inc
Organization subpart
Yes
Provider details
NPI number
Legal business name
AT HOME INC
Authorized official
MR. PATRICK ROBERT STONICH RN,BSN (DIRECTOR OF NURSING)
(267) 319-1530
Entity
Organization
Contact information
Practice address
415 BUSINESS PARK LN, ALLENTOWN, PA 18109-9120
(267) 319-1530
(267) 319-1531
Mailing address
1233 LOCUST STREET, SUITE 304, PHILADELPHIA, PA 19107
(267) 319-1530
(267) 319-1531
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1018007450002
—
PA
05
—
1021082020001
—
PA
05
—
1021141200001
—
PA
05
—
1021144150001
—
PA
05
—
1022406620001
—
PA
01
—
1083814933
NPI ERIC
PA
Enumeration date
01/04/2008
Last updated
08/17/2010
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