Provider Demographics
NPI:1326041732
Name:BACONSFIELD HOMECARE EQUIPMENT INC
Entity Type:Organization
Organization Name:BACONSFIELD HOMECARE EQUIPMENT INC
Other - Org Name:CHICHESTERS HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-743-4557
Mailing Address - Street 1:1042 GRAY HWY
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211-1837
Mailing Address - Country:US
Mailing Address - Phone:478-743-4557
Mailing Address - Fax:478-742-4522
Practice Address - Street 1:1042 GRAY HWY
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31211-1837
Practice Address - Country:US
Practice Address - Phone:478-743-4557
Practice Address - Fax:478-742-4522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000023185BMedicaid
GA000683856AMedicaid
GA0399530001Medicare NSC