Provider Demographics
NPI:1295325488
Name:HOME DIAGNOSTICS ON WHEELS
Entity type:Organization
Organization Name:HOME DIAGNOSTICS ON WHEELS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCENA
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-254-3658
Mailing Address - Street 1:1030 SUMMIT PLACE CIRCLE, C
Mailing Address - Street 2:C
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415
Mailing Address - Country:US
Mailing Address - Phone:561-254-3658
Mailing Address - Fax:
Practice Address - Street 1:1030 SUMMIT PLACE CIR # 05082017
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-4700
Practice Address - Country:US
Practice Address - Phone:561-254-3658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service