Provider Demographics
NPI:1992840151
Name:HOME DIABETIC SUPPLIES LLC
Entity Type:Organization
Organization Name:HOME DIABETIC SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:NATIVIDAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-223-9128
Mailing Address - Street 1:1716 S SAN MARCOS
Mailing Address - Street 2:SUITE 25
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-7094
Mailing Address - Country:US
Mailing Address - Phone:210-223-9981
Mailing Address - Fax:210-223-9128
Practice Address - Street 1:1716 S SAN MARCOS
Practice Address - Street 2:SUITE 25
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-7094
Practice Address - Country:US
Practice Address - Phone:210-223-9981
Practice Address - Fax:210-223-9128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192417702Medicaid
TX192417701Medicaid
TX192417701Medicaid