Provider Demographics
NPI:1134324965
Name:AMERICAN HOMECARE SUPPLY COMPANY
Entity Type:Organization
Organization Name:AMERICAN HOMECARE SUPPLY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:PARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-963-0744
Mailing Address - Street 1:4113 BIRNEY AVE
Mailing Address - Street 2:
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18507-1301
Mailing Address - Country:US
Mailing Address - Phone:570-961-0155
Mailing Address - Fax:570-961-1802
Practice Address - Street 1:747 E CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-8138
Practice Address - Country:US
Practice Address - Phone:717-274-9109
Practice Address - Fax:717-274-9617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA8000001380332B00000X, 332BP3500X, 332BX2000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1196210010Medicare NSC