Provider Demographics
NPI:1720162977
Name:CONVALESCENT HOME EQUIPMENT, INC.
Entity Type:Organization
Organization Name:CONVALESCENT HOME EQUIPMENT, INC.
Other - Org Name:CONVALESCENT HOME CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CSR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:W
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-886-8474
Mailing Address - Street 1:PO BOX 116
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-1401
Mailing Address - Country:US
Mailing Address - Phone:706-886-8474
Mailing Address - Fax:706-886-7032
Practice Address - Street 1:3002 FALLS RD
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-1401
Practice Address - Country:US
Practice Address - Phone:706-886-8474
Practice Address - Fax:706-886-7032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0139690001Medicare NSC