Basic Information
| Provider Information | |||||||||
| NPI: | 1639479140 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOME HEALTH DEPOT | ||||||||
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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: | 13 WESTPORT CT | ||||||||
| Address2: | UNIT B | ||||||||
| City: | BLOOMINGTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 617043626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3096624000 | ||||||||
| FaxNumber: | 3173336034 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2010 | ||||||||
| LastUpdateDate: | 10/31/2010 | ||||||||
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| AuthorizedOfficialLastName: | GOLDMAN | ||||||||
| AuthorizedOfficialFirstName: | TERRI | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF CONTRACTING | ||||||||
| AuthorizedOfficialTelephone: | 3173336033 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332BC3200X | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
No ID Information.