Basic Information
| Provider Information | |||||||||
| NPI: | 1225133671 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | QUALITY HOME MEDICAL INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 ROGERS COMMERCE BLVD | ||||||||
| Address2: | |||||||||
| City: | BOILING SPRINGS | ||||||||
| State: | SC | ||||||||
| PostalCode: | 293166144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645999945 | ||||||||
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| Practice Location | |||||||||
| Address1: | 247 OAK ST | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | FOREST CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280433539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282881289 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 06/03/2013 | ||||||||
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| AuthorizedOfficialLastName: | FULLER | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 8645999945 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 7703335 | 05 | NC | MEDICAID |