Provider Demographics
NPI:1497746218
Name:HOME IV CARE AND NUTRITIONAL SERVICE
Entity Type:Organization
Organization Name:HOME IV CARE AND NUTRITIONAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MORSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-353-0300
Mailing Address - Street 1:340 HILL CARTER PKWY
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-2324
Mailing Address - Country:US
Mailing Address - Phone:804-752-3415
Mailing Address - Fax:804-752-3418
Practice Address - Street 1:340 HILL CARTER PKWY
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-2324
Practice Address - Country:US
Practice Address - Phone:804-752-3415
Practice Address - Fax:804-752-3418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201003066333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0201003066OtherBOARD OF PHARMACY
0563960001Medicare NSC