Provider Demographics
NPI:1053312678
Name:OPTION ONE HOME MEDICAL EQUIPMENT, INC
Entity Type:Organization
Organization Name:OPTION ONE HOME MEDICAL EQUIPMENT, INC
Other - Org Name:PREFERRED HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGULATORY AFFAIRS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-446-9010
Mailing Address - Street 1:PO BOX 40700
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85274-0700
Mailing Address - Country:US
Mailing Address - Phone:800-834-1092
Mailing Address - Fax:951-271-4679
Practice Address - Street 1:830 E PARKRIDGE AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-6611
Practice Address - Country:US
Practice Address - Phone:800-834-1092
Practice Address - Fax:909-273-0193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-04
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43744332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME01003GMedicaid
CADME01003GMedicaid