Provider Demographics
NPI:1750994034
Name:FAMILY HOME MEDICAL EQUIPMENT, LLC
Entity type:Organization
Organization Name:FAMILY HOME MEDICAL EQUIPMENT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERPOOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-771-6501
Mailing Address - Street 1:1701 BOULEVARD SQ STE C
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-8022
Mailing Address - Country:US
Mailing Address - Phone:912-590-6546
Mailing Address - Fax:912-590-6550
Practice Address - Street 1:405 WARD ST. W
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533
Practice Address - Country:US
Practice Address - Phone:912-720-6546
Practice Address - Fax:912-720-6550
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY HOME MEDICAL EQUIPMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-26
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003191517AMedicaid
GA003244792AMedicaid