Provider Demographics
NPI:1508826199
Name:THE HOME HEALTH STORE OF TOMBALL, INC.
Entity Type:Organization
Organization Name:THE HOME HEALTH STORE OF TOMBALL, INC.
Other - Org Name:HOME HEALTH STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:FRED
Authorized Official - Last Name:GLOYER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:281-351-6216
Mailing Address - Street 1:444 HOLDERRIETH BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4591
Mailing Address - Country:US
Mailing Address - Phone:281-351-6216
Mailing Address - Fax:281-351-7989
Practice Address - Street 1:444 HOLDERRIETH BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4591
Practice Address - Country:US
Practice Address - Phone:281-351-6216
Practice Address - Fax:281-351-7989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BC3200X, 332BX2000X
TX16897332BP3500X, 333600000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0198060001Medicare NSC