Provider Demographics
NPI:1982629812
Name:HOME CARE SUPPLY, LLC
Entity Type:Organization
Organization Name:HOME CARE SUPPLY, LLC
Other - Org Name:PRAXAIR HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:KALTRIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-837-2330
Mailing Address - Street 1:P.O. BOX 121119
Mailing Address - Street 2:DEPT 1119
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-1119
Mailing Address - Country:US
Mailing Address - Phone:409-951-6437
Mailing Address - Fax:409-654-2068
Practice Address - Street 1:714 W GIBSON ST
Practice Address - Street 2:SUITE 7
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-4958
Practice Address - Country:US
Practice Address - Phone:409-489-9105
Practice Address - Fax:409-489-5198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1530636-02Medicaid
TX1530636-01Medicaid
1134680013Medicare NSC