Provider Demographics
NPI:1114909330
Name:HOMELIFE OXYGEN, LLC
Entity Type:Organization
Organization Name:HOMELIFE OXYGEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:FOUST
Authorized Official - Suffix:
Authorized Official - Credentials:RRT, BPS
Authorized Official - Phone:901-373-3503
Mailing Address - Street 1:13 CYPRESS CRK
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-9747
Mailing Address - Country:US
Mailing Address - Phone:870-739-4033
Mailing Address - Fax:901-372-3610
Practice Address - Street 1:1675 N SHELBY OAKS DR
Practice Address - Street 2:SUITE #1
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-7430
Practice Address - Country:US
Practice Address - Phone:901-373-3503
Practice Address - Fax:901-372-3610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1452198Medicaid
MS0440365Medicaid
TN3016454OtherBLUE CROSS BLUE SHIELD
TN1452198Medicaid
TN1452198Medicaid