Provider Demographics
NPI:1457423634
Name:HOMESIDE HEALTHCARE INC
Entity Type:Organization
Organization Name:HOMESIDE HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:W
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-563-9400
Mailing Address - Street 1:1315 US 68
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-9132
Mailing Address - Country:US
Mailing Address - Phone:606-563-9400
Mailing Address - Fax:606-564-4144
Practice Address - Street 1:1315 US 68 SOUTHGATE PLAZA
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-9132
Practice Address - Country:US
Practice Address - Phone:606-563-9400
Practice Address - Fax:606-564-4144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000229563OtherANTHEM
KY90003476Medicaid
OH2324783OtherMEDICAID
KY4390100001Medicare ID - Type Unspecified
KY90003476Medicaid