Basic Information
| Provider Information | |||||||||
| NPI: | 1841709201 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDILINK HOMECARE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19387 US HIGHWAY 19 N | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337643102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002842006 | ||||||||
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| Practice Location | |||||||||
| Address1: | 463 N WHITE HORSE PIKE | ||||||||
| Address2: | |||||||||
| City: | HAMMONTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080371881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095672241 | ||||||||
| FaxNumber: | 6095670503 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2017 | ||||||||
| LastUpdateDate: | 09/28/2017 | ||||||||
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| AuthorizedOfficialLastName: | MCCARTHY | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7275307700 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MEDILINK HOMECARE, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 28RS00502800 | NJ | N | Suppliers | Durable Medical Equipment & Medical Supplies | 3336H0001X | 28RS00502800 | NJ | Y | Suppliers | Pharmacy | Home Infusion Therapy Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 6441904 | 05 | NJ | MEDICAID |