Provider Demographics
NPI:1083888283
Name:EBERHART HOME HEALTH INC
Entity Type:Organization
Organization Name:EBERHART HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:EBERHART
Authorized Official - Suffix:
Authorized Official - Credentials:RCP/RRT
Authorized Official - Phone:949-367-1868
Mailing Address - Street 1:3751 N BUTLER AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-6435
Mailing Address - Country:US
Mailing Address - Phone:505-716-4238
Mailing Address - Fax:505-326-5042
Practice Address - Street 1:3751 N BUTLER AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-6435
Practice Address - Country:US
Practice Address - Phone:505-716-4238
Practice Address - Fax:505-326-5042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM50553569Medicaid
NM50553569Medicaid