Provider Demographics
NPI:1750097135
Name:MY HOME MEDICAL LLC
Entity type:Organization
Organization Name:MY HOME MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:801-540-5580
Mailing Address - Street 1:6595 S SILVER OAK LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEBER
Mailing Address - State:UT
Mailing Address - Zip Code:84405-9741
Mailing Address - Country:US
Mailing Address - Phone:801-540-5580
Mailing Address - Fax:
Practice Address - Street 1:6595 S SILVER OAK LN
Practice Address - Street 2:
Practice Address - City:SOUTH WEBER
Practice Address - State:UT
Practice Address - Zip Code:84405-9741
Practice Address - Country:US
Practice Address - Phone:801-540-5580
Practice Address - Fax:832-324-6932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty