Provider Demographics
NPI:1508873605
Name:DURA-MED HOME CARE LLC
Entity Type:Organization
Organization Name:DURA-MED HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:479-738-1870
Mailing Address - Street 1:720 N GASKILL ST
Mailing Address - Street 2:STE 11
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72740
Mailing Address - Country:US
Mailing Address - Phone:479-738-1870
Mailing Address - Fax:479-738-1091
Practice Address - Street 1:720 N GASKILL ST
Practice Address - Street 2:STE 11
Practice Address - City:HUNTSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72740-9104
Practice Address - Country:US
Practice Address - Phone:479-738-1870
Practice Address - Fax:479-738-1091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR163492716Medicaid
AR163492716Medicaid