Provider Demographics
NPI:1487824561
Name:DMR HOMECARE LLC
Entity Type:Organization
Organization Name:DMR HOMECARE LLC
Other - Org Name:DMR-N-SALES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-494-9990
Mailing Address - Street 1:2300 E TANGER DR STE 109
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-9630
Mailing Address - Country:US
Mailing Address - Phone:520-494-9990
Mailing Address - Fax:520-494-9122
Practice Address - Street 1:2300 E TANGER DR
Practice Address - Street 2:SUITE 109
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-9608
Practice Address - Country:US
Practice Address - Phone:520-494-9990
Practice Address - Fax:520-494-9122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20262380332B00000X
AZC000764332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ305033Medicaid
AZ305033Medicaid