Provider Demographics
NPI:1740356807
Name:HOMEDIC INC
Entity type:Organization
Organization Name:HOMEDIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:VERONICA
Authorized Official - Last Name:FENTRESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-422-1112
Mailing Address - Street 1:671 E COOLEY DRIVE # 104
Mailing Address - Street 2:PO BOX 1344
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324
Mailing Address - Country:US
Mailing Address - Phone:909-422-1121
Mailing Address - Fax:909-422-1191
Practice Address - Street 1:671 E COOLEY DRIVE # 104
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324
Practice Address - Country:US
Practice Address - Phone:909-422-1121
Practice Address - Fax:909-422-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME01319GMedicaid
CADME01319GMedicaid