Provider Demographics
NPI:1821010828
Name:PERFORMANCE HOME MEDICAL EQUIPMENT, LLC
Entity Type:Organization
Organization Name:PERFORMANCE HOME MEDICAL EQUIPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:JEWELL
Authorized Official - Last Name:GREMILLION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:2256-638-4644
Mailing Address - Street 1:PO BOX 929
Mailing Address - Street 2:
Mailing Address - City:NEW ROADS
Mailing Address - State:LA
Mailing Address - Zip Code:70760-0929
Mailing Address - Country:US
Mailing Address - Phone:225-638-4644
Mailing Address - Fax:225-638-4645
Practice Address - Street 1:2312 FALSE RIVER DR
Practice Address - Street 2:SUITE B
Practice Address - City:NEW ROADS
Practice Address - State:LA
Practice Address - Zip Code:70760-2508
Practice Address - Country:US
Practice Address - Phone:225-638-4644
Practice Address - Fax:225-638-4645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1723355Medicaid
LA1723355Medicaid