1114909330 NPI number — HOMELIFE OXYGEN, LLC

Table of content: (NPI 1114909330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114909330 NPI number — HOMELIFE OXYGEN, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOMELIFE OXYGEN, 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:
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:
1114909330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13 CYPRESS CRK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARION
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72364-9747
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-739-4033
Provider Business Mailing Address Fax Number:
901-372-3610

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1675 N SHELBY OAKS DR
Provider Second Line Business Practice Location Address:
SUITE #1
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38134-7430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-373-3503
Provider Business Practice Location Address Fax Number:
901-372-3610
Provider Enumeration Date:
11/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FOUST
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
NEIL
Authorized Official Title or Position:
CHIEF MANAGER/OWNER
Authorized Official Telephone Number:
901-373-3503

Provider Taxonomy Codes

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

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

  • Identifier: 1452198 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0440365 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3016454 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com