Provider Demographics
NPI:1477589430
Name:ALICK'S HOME MEDICAL EQUIPMENT, INC.
Entity Type:Organization
Organization Name:ALICK'S HOME MEDICAL EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NAFE
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:ALICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-273-6000
Mailing Address - Street 1:1612 W LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-1942
Mailing Address - Country:US
Mailing Address - Phone:574-522-2273
Mailing Address - Fax:574-522-4563
Practice Address - Street 1:1612 W LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-1942
Practice Address - Country:US
Practice Address - Phone:574-522-2273
Practice Address - Fax:574-522-4563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI872778403Medicaid
IN100178390Medicaid
IN000000303875OtherANTHEM BCBS
IN100178390Medicaid