Basic Information
| Provider Information | |||||||||
| NPI: | 1790057701 | ||||||||
| 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: | 6004 HIGHVIEW DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468181383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2603991355 | ||||||||
| FaxNumber: | 2603991344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2012 | ||||||||
| LastUpdateDate: | 06/04/2012 | ||||||||
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| AuthorizedOfficialLastName: | HARTLEY | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3173336033 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | IN | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332BC3200X | IN | N | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment | 332BX2000X | 69000965A | IN | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |
No ID Information.