Provider Demographics
NPI:1740895580
Name:HOME DELIVERY INCONTINENT SUPPLIES CO INC
Entity type:Organization
Organization Name:HOME DELIVERY INCONTINENT SUPPLIES CO INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-997-8771
Mailing Address - Street 1:9385 DIELMAN INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:OLIVETTE
Mailing Address - State:MO
Mailing Address - Zip Code:63132-2214
Mailing Address - Country:US
Mailing Address - Phone:314-997-8771
Mailing Address - Fax:314-997-0997
Practice Address - Street 1:801 BROAD ST STE 602
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-1227
Practice Address - Country:US
Practice Address - Phone:800-367-8360
Practice Address - Fax:888-874-4347
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOURNEY DPC CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-09
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies