Provider Demographics
NPI:1750823050
Name:MED-LINE SUPPORT INC
Entity Type:Organization
Organization Name:MED-LINE SUPPORT INC
Other - Org Name:RIGHT AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-824-0700
Mailing Address - Street 1:1514 ELECTRIC AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15112-1337
Mailing Address - Country:US
Mailing Address - Phone:412-824-0700
Mailing Address - Fax:
Practice Address - Street 1:1514 ELECTRIC AVE
Practice Address - Street 2:
Practice Address - City:EAST PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15112-1337
Practice Address - Country:US
Practice Address - Phone:412-824-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA10733601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care