Provider Demographics
NPI:1912104449
Name:OPTION ONE HOME MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:OPTION ONE HOME MEDICAL EQUIPMENT
Other - Org Name:PREFERRED HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGULATORY AFFAIRS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-446-9010
Mailing Address - Street 1:PO BOX 40700
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85274-0700
Mailing Address - Country:US
Mailing Address - Phone:800-834-1092
Mailing Address - Fax:949-951-4679
Practice Address - Street 1:39725 GARAND LN STE B
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-7126
Practice Address - Country:US
Practice Address - Phone:866-205-9067
Practice Address - Fax:760-200-9302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103599332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1095710003Medicare NSC