Provider Demographics
NPI:1760573091
Name:HOMEDEQ
Entity Type:Organization
Organization Name:HOMEDEQ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:RODGER
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-748-6225
Mailing Address - Street 1:PO BOX 25242
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77265-5242
Mailing Address - Country:US
Mailing Address - Phone:713-748-6225
Mailing Address - Fax:713-747-9076
Practice Address - Street 1:107 W WAY ST
Practice Address - Street 2:SUITE 15
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5219
Practice Address - Country:US
Practice Address - Phone:979-297-3603
Practice Address - Fax:979-297-3693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00559252332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX55952OtherTX DEPT OF HEALTH LISC
TX========= OUTLET 6OtherFED TAX ID
TX55952OtherTX DEPT OF HEALTH LISC