Provider Demographics
NPI:1609968221
Name:AT HOME MEDICAL SUPPLIES LLC
Entity Type:Organization
Organization Name:AT HOME MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-333-3392
Mailing Address - Street 1:350 WALLACE RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4883
Mailing Address - Country:US
Mailing Address - Phone:615-333-3392
Mailing Address - Fax:615-333-3810
Practice Address - Street 1:350 WALLACE RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4883
Practice Address - Country:US
Practice Address - Phone:615-333-3392
Practice Address - Fax:615-333-3810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002400332B00000X
332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1455011Medicaid
TN1455011Medicaid