Provider Demographics
NPI:1861469959
Name:HOME RESPIRATORY CARE INC
Entity Type:Organization
Organization Name:HOME RESPIRATORY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRET
Authorized Official - Middle Name:J
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:CRTT
Authorized Official - Phone:904-966-0520
Mailing Address - Street 1:417B EDWARDS RD
Mailing Address - Street 2:
Mailing Address - City:STARKE
Mailing Address - State:FL
Mailing Address - Zip Code:32091-3903
Mailing Address - Country:US
Mailing Address - Phone:904-966-0520
Mailing Address - Fax:904-966-0521
Practice Address - Street 1:417B EDWARDS RD
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-3903
Practice Address - Country:US
Practice Address - Phone:904-966-0520
Practice Address - Fax:904-966-0521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1434332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM2553OtherBCBS
FL022879600Medicaid
FL=========OtherTRICARE
FL=========OtherTRICARE