Provider Demographics
NPI:1811913189
Name:HOME CARE SUPPLY LLC
Entity type:Organization
Organization Name:HOME CARE SUPPLY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:KALTRIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-837-2330
Mailing Address - Street 1:P.O. BOX 121143
Mailing Address - Street 2:DEPT 1143
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-1143
Mailing Address - Country:US
Mailing Address - Phone:409-951-6473
Mailing Address - Fax:409-654-2068
Practice Address - Street 1:226 N HOLLYWOOD RD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70364-2808
Practice Address - Country:US
Practice Address - Phone:985-223-1528
Practice Address - Fax:985-223-1530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2009-02-11
Deactivation Date:2008-12-26
Deactivation Code:
Reactivation Date:2009-02-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1190128Medicaid
LA1190128Medicaid