Provider Demographics
NPI:1376567859
Name:IN HOME CARE LLC
Entity Type:Organization
Organization Name:IN HOME CARE LLC
Other - Org Name:LIFE GUARD MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:GALE
Authorized Official - Last Name:CLEVENGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-659-3535
Mailing Address - Street 1:PO BOX 386
Mailing Address - Street 2:108 PULLMAN DRIVE
Mailing Address - City:PENNSBORO
Mailing Address - State:WV
Mailing Address - Zip Code:26415
Mailing Address - Country:US
Mailing Address - Phone:304-659-3535
Mailing Address - Fax:304-659-3118
Practice Address - Street 1:108 PULLMAN DR
Practice Address - Street 2:
Practice Address - City:PENNSBORO
Practice Address - State:WV
Practice Address - Zip Code:26415
Practice Address - Country:US
Practice Address - Phone:304-659-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002357Medicaid
5403930001Medicare ID - Type Unspecified