Provider Demographics
NPI:1407375546
Name:HOME MEDICAL SUPPLIES LLC
Entity Type:Organization
Organization Name:HOME MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:
Authorized Official - Last Name:CHABAYTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-514-4084
Mailing Address - Street 1:4340 LAURIAN DR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-5182
Mailing Address - Country:US
Mailing Address - Phone:770-343-9929
Mailing Address - Fax:
Practice Address - Street 1:3939 ROYAL DR NW STE 109
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6453
Practice Address - Country:US
Practice Address - Phone:770-343-9929
Practice Address - Fax:678-716-8786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-10
Last Update Date:2017-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies