Provider Demographics
NPI:1184616906
Name:HOSPITAL EQUIPMENT AND HOME NUTRITIONAL THERAPY, INC
Entity type:Organization
Organization Name:HOSPITAL EQUIPMENT AND HOME NUTRITIONAL THERAPY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:205-428-5113
Mailing Address - Street 1:119 HIGHLANDER DR
Mailing Address - Street 2:
Mailing Address - City:HUEYTOWN
Mailing Address - State:AL
Mailing Address - Zip Code:35023-2720
Mailing Address - Country:US
Mailing Address - Phone:205-491-6836
Mailing Address - Fax:205-424-6786
Practice Address - Street 1:727 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-6029
Practice Address - Country:US
Practice Address - Phone:205-428-5113
Practice Address - Fax:205-424-6786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL05001347332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL56588OtherBLUE CROSS BLUE SHIELD
AL1404366OtherUMWA
AL=========OtherVIVA MEDICARE PLUS
AL=========OtherVIVA MEDICARE PLUS