Provider Demographics
NPI:1093823296
Name:HOMECARE MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:HOMECARE MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BENAVIDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-664-0991
Mailing Address - Street 1:717 FLOURNOY RD
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4003
Mailing Address - Country:US
Mailing Address - Phone:361-664-0991
Mailing Address - Fax:361-664-4999
Practice Address - Street 1:717 FLOURNOY RD
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4003
Practice Address - Country:US
Practice Address - Phone:361-664-0991
Practice Address - Fax:361-664-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX0011732332B00000X
TX0034193332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010131301Medicaid
TX011583401Medicaid
TX011583401Medicaid