Provider Demographics
NPI:1033398482
Name:HUEY'S HOME MEDICAL, INC
Entity Type:Organization
Organization Name:HUEY'S HOME MEDICAL, INC
Other - Org Name:HUEY'S HOME MEDICAL, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-206-0040
Mailing Address - Street 1:2084 OTAY LAKES ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1368
Mailing Address - Country:US
Mailing Address - Phone:619-600-3276
Mailing Address - Fax:619-779-7166
Practice Address - Street 1:1207 S MATTIS AVE STE 1
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-4862
Practice Address - Country:US
Practice Address - Phone:217-356-4839
Practice Address - Fax:217-666-4128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid