Provider Demographics
NPI:1801020052
Name:MY SACRED HOME DME/HME,LLC
Entity Type:Organization
Organization Name:MY SACRED HOME DME/HME,LLC
Other - Org Name:MSH DME
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANNIFER
Authorized Official - Middle Name:S
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:316-440-4820
Mailing Address - Street 1:1837 N ROCK ROAD CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1251
Mailing Address - Country:US
Mailing Address - Phone:316-440-7501
Mailing Address - Fax:316-558-5479
Practice Address - Street 1:1837 N ROCK ROAD CT
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1251
Practice Address - Country:US
Practice Address - Phone:316-440-7501
Practice Address - Fax:316-558-5479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies