Provider Demographics
NPI:1265480982
Name:LINRAY HOME MEDICAL SUPPLIES OF ELKHART
Entity Type:Organization
Organization Name:LINRAY HOME MEDICAL SUPPLIES OF ELKHART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:FRESHOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-522-5706
Mailing Address - Street 1:56595 PINECREST DR
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-9157
Mailing Address - Country:US
Mailing Address - Phone:574-295-1330
Mailing Address - Fax:
Practice Address - Street 1:23672 OLD US 20
Practice Address - Street 2:SUITES G AND H
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-5584
Practice Address - Country:US
Practice Address - Phone:574-522-5706
Practice Address - Fax:574-522-5762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0122971078332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5659020001Medicare NSC