Provider Demographics
NPI:1518509512
Name:HOMEBOUND MEDICAL LLC
Entity Type:Organization
Organization Name:HOMEBOUND MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-551-9628
Mailing Address - Street 1:20124 LAUDER ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-1659
Mailing Address - Country:US
Mailing Address - Phone:313-551-9628
Mailing Address - Fax:
Practice Address - Street 1:20124 LAUDER ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-1659
Practice Address - Country:US
Practice Address - Phone:313-551-9628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health