Provider Demographics
NPI:1841278918
Name:CENTRAL HOME MEDICAL INC.
Entity type:Organization
Organization Name:CENTRAL HOME MEDICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:LUKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:760-352-3456
Mailing Address - Street 1:598 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-2418
Mailing Address - Country:US
Mailing Address - Phone:760-352-3456
Mailing Address - Fax:760-312-9504
Practice Address - Street 1:598 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2418
Practice Address - Country:US
Practice Address - Phone:760-352-3456
Practice Address - Fax:760-312-9504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFHA97-822245332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME03288FMedicaid
CA5529860001Medicare NSC