Provider Demographics
NPI:1467960708
Name:HOMETOWN OXYGEN CHARLOTTE LLC
Entity Type:Organization
Organization Name:HOMETOWN OXYGEN CHARLOTTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:VOORHEES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-692-2747
Mailing Address - Street 1:41 SPRING ST.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974
Mailing Address - Country:US
Mailing Address - Phone:803-873-9985
Mailing Address - Fax:704-784-0055
Practice Address - Street 1:1700 ALTA VISTA DR STE 250
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4559
Practice Address - Country:US
Practice Address - Phone:803-873-9985
Practice Address - Fax:704-793-1610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17355332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC17355OtherSC BOARD OF PHARMACY