Provider Demographics
NPI:1538123021
Name:COMFORTCARE MED SUPPLY INC
Entity Type:Organization
Organization Name:COMFORTCARE MED SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-530-7848
Mailing Address - Street 1:2898B WILLOW COVE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-1636
Mailing Address - Country:US
Mailing Address - Phone:866-530-7848
Mailing Address - Fax:866-530-7811
Practice Address - Street 1:2898B WILLOW COVE DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-1636
Practice Address - Country:US
Practice Address - Phone:866-530-7848
Practice Address - Fax:866-530-7811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00796332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7705075Medicaid
NC7705075Medicaid