Provider Demographics
NPI:1265964886
Name:PERSONAL HME LLC
Entity type:Organization
Organization Name:PERSONAL HME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHISH
Authorized Official - Middle Name:
Authorized Official - Last Name:POORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-816-4873
Mailing Address - Street 1:5346 S 136TH ST
Mailing Address - Street 2:390081
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-3001
Mailing Address - Country:US
Mailing Address - Phone:269-491-7369
Mailing Address - Fax:
Practice Address - Street 1:5346 S 136TH ST
Practice Address - Street 2:390081
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-3001
Practice Address - Country:US
Practice Address - Phone:269-491-7369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-02
Last Update Date:2017-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies