Provider Demographics
NPI:1114972106
Name:HOME INFUSION SERVICES INC
Entity Type:Organization
Organization Name:HOME INFUSION SERVICES INC
Other - Org Name:LAKELAND HOME INFUSION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIVISION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:EFFA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MBA
Authorized Official - Phone:269-985-4441
Mailing Address - Street 1:PO BOX 813
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-0813
Mailing Address - Country:US
Mailing Address - Phone:269-985-4422
Mailing Address - Fax:269-985-4423
Practice Address - Street 1:2550 MEADOWBROOK RD STE 106
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-9609
Practice Address - Country:US
Practice Address - Phone:269-985-4422
Practice Address - Fax:269-982-0224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MI53010055923336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2349644OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MI2742474Medicaid
MI2742474Medicaid