1083630396 NPI number — HOME CARE SUPPLY LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083630396 NPI number — HOME CARE SUPPLY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOME CARE SUPPLY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083630396
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
203 E 6100 S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84107-7302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-261-7139
Provider Business Mailing Address Fax Number:
801-288-5906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5400 PEPSI ST
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70123-3227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-734-2030
Provider Business Practice Location Address Fax Number:
409-654-2068
Provider Enumeration Date:
07/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KALTRIDER
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
203-837-2330

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00440730 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1545856 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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