Provider Demographics
NPI:1821051707
Name:FAMILY HOME MEDICAL EQUIPMENT AND SUPPLIES
Entity Type:Organization
Organization Name:FAMILY HOME MEDICAL EQUIPMENT AND SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:JACKSON-WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-735-6020
Mailing Address - Street 1:7816 PARSTON DR
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20747-4424
Mailing Address - Country:US
Mailing Address - Phone:301-735-6020
Mailing Address - Fax:301-735-6021
Practice Address - Street 1:7816 PARSTON DR
Practice Address - Street 2:
Practice Address - City:FORESTVILLE
Practice Address - State:MD
Practice Address - Zip Code:20747-4424
Practice Address - Country:US
Practice Address - Phone:301-735-6020
Practice Address - Fax:301-735-6021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC036518300Medicaid
MD002805300Medicaid
DC036518300Medicaid