Provider Demographics
NPI:1568574416
Name:ELY HOME INFUSION INC.
Entity Type:Organization
Organization Name:ELY HOME INFUSION INC.
Other - Org Name:LOCAL HOME INFUSION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDNALL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:270-651-5159
Mailing Address - Street 1:ELY HOME INFUSION
Mailing Address - Street 2:109 MORAN STREET STE A
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141
Mailing Address - Country:US
Mailing Address - Phone:270-467-5220
Mailing Address - Fax:270-629-6320
Practice Address - Street 1:ELY HOME INFUSION
Practice Address - Street 2:109 MORAN STREET STE A
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141
Practice Address - Country:US
Practice Address - Phone:270-467-5220
Practice Address - Fax:270-629-6320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
KYP075033336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2134817OtherPK