Provider Demographics
NPI:1871645739
Name:MOORE HOME MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:MOORE HOME MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUDEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGELETY-MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:219-392-6858
Mailing Address - Street 1:PO BOX 1733
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46409-0733
Mailing Address - Country:US
Mailing Address - Phone:219-392-3189
Mailing Address - Fax:219-392-3193
Practice Address - Street 1:517 EXCHANGE AVE
Practice Address - Street 2:
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-3223
Practice Address - Country:US
Practice Address - Phone:219-392-3189
Practice Address - Fax:219-392-3193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies