Provider Demographics
NPI:1629091863
Name:HOME HEALTH MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:HOME HEALTH MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GESTEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-887-4847
Mailing Address - Street 1:1281 W RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46408
Mailing Address - Country:US
Mailing Address - Phone:219-887-4847
Mailing Address - Fax:219-981-8442
Practice Address - Street 1:1281 W RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46408
Practice Address - Country:US
Practice Address - Phone:219-887-4847
Practice Address - Fax:219-981-8442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
3910910001Medicare ID - Type Unspecified