Provider Demographics
NPI:1871503714
Name:DICKS HOME CARE INC
Entity Type:Organization
Organization Name:DICKS HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-949-6764
Mailing Address - Street 1:401 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4170
Mailing Address - Country:US
Mailing Address - Phone:814-949-6764
Mailing Address - Fax:814-949-6767
Practice Address - Street 1:1300 BENNER PIKE
Practice Address - Street 2:STE 3
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7325
Practice Address - Country:US
Practice Address - Phone:814-867-1970
Practice Address - Fax:814-867-1973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007550730018Medicaid
PA232694OtherHIGHMARK
PA39HA34OtherCAPITAL BLUE CROSS
PA1007550730018Medicaid