Provider Demographics
NPI:1801825054
Name:MARY'S HEART HOME MEDICAL SUPPLY
Entity Type:Organization
Organization Name:MARY'S HEART HOME MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENNETT
Authorized Official - Middle Name:W
Authorized Official - Last Name:MORAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-623-4109
Mailing Address - Street 1:PO BOX 668
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71353-0668
Mailing Address - Country:US
Mailing Address - Phone:337-623-4109
Mailing Address - Fax:337-623-4102
Practice Address - Street 1:226 LYONS ST
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:LA
Practice Address - Zip Code:71353-0668
Practice Address - Country:US
Practice Address - Phone:337-623-4109
Practice Address - Fax:337-623-4102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA562576565332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1409081Medicaid
LA5744110001Medicare NSC