Provider Demographics
NPI:1700023835
Name:HOME SWEET HOME IN HOME MEDICAL LLC
Entity Type:Organization
Organization Name:HOME SWEET HOME IN HOME MEDICAL LLC
Other - Org Name:LIFE GUARD MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VOGT-MCCLOY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:304-659-3535
Mailing Address - Street 1:PO BOX 75
Mailing Address - Street 2:
Mailing Address - City:PENNSBORO
Mailing Address - State:WV
Mailing Address - Zip Code:26415-0075
Mailing Address - Country:US
Mailing Address - Phone:304-659-3535
Mailing Address - Fax:304-659-3118
Practice Address - Street 1:206 KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:PENNSBORO
Practice Address - State:WV
Practice Address - Zip Code:26415-1315
Practice Address - Country:US
Practice Address - Phone:304-659-3535
Practice Address - Fax:304-659-3118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2218-1728332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6248960001Medicare NSC