Basic Information
| Provider Information | |||||||||
| NPI: | 1609935584 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOME HEALTH DEPOT, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9245 N MERIDIAN ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462601836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173336033 | ||||||||
| FaxNumber: | 3173336034 | ||||||||
| Practice Location | |||||||||
| Address1: | 7040 GUION RD | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462684812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173336033 | ||||||||
| FaxNumber: | 3173336034 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2006 | ||||||||
| LastUpdateDate: | 02/10/2012 | ||||||||
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| AuthorizedOfficialLastName: | HARTLEY | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3173336033 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | HMER 22686 | OH | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332BC3200X | HMER 22686 | OH | N | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment | 332BX2000X | HMER 22686 | OH | N | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies | 332B00000X | 69000543A | IN | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332BX2000X | 69000543A | IN | N | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies | 332BX2000X | 831955559 | IN | N | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies | 332BX2000X | MG0784 | KY | N | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies | 332BX2000X | 600262 | MN | N | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies | 332BC3200X | 69000543A | IN | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
ID Information
| ID | Type | State | Issuer | Description | 000000097481 | 01 | IN | ANTHEM BC/BS | OTHER | 200951220A | 05 | IN | MEDICAID | 200206500A | 05 | IN | MEDICAID |