Provider Demographics
NPI:1215018387
Name:COMPLETE HOME CARE SUPPLY INC.
Entity Type:Organization
Organization Name:COMPLETE HOME CARE SUPPLY INC.
Other - Org Name:COMPLETE HOME CARE SUPPLY INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERAL
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-280-2050
Mailing Address - Street 1:5309 MCCLANAHAN DRIVE, STE. F-4
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116
Mailing Address - Country:US
Mailing Address - Phone:800-280-2050
Mailing Address - Fax:501-753-1635
Practice Address - Street 1:5309 MCCLANAHAN DR STE F4
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7075
Practice Address - Country:US
Practice Address - Phone:800-280-2050
Practice Address - Fax:501-753-1635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0000001546332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR141600716Medicaid
AR141600716Medicaid