Provider Demographics
NPI:1194820613
Name:HOMESTEAD MEDICAL EQUIPMENT & SUPPLIES, INC
Entity Type:Organization
Organization Name:HOMESTEAD MEDICAL EQUIPMENT & SUPPLIES, INC
Other - Org Name:HME PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-242-4129
Mailing Address - Street 1:1457 N KROME AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4208
Mailing Address - Country:US
Mailing Address - Phone:305-242-4129
Mailing Address - Fax:
Practice Address - Street 1:1457 N KROME AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4208
Practice Address - Country:US
Practice Address - Phone:305-242-4129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1312012332B00000X
FL3203601332BX2000X
FL225683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3203601OtherMEDICAL OXYGEN
FL1312012OtherAHCA
FL1312012OtherAHCA