Provider Demographics
NPI:1912936147
Name:NORTHERN HOME MEDICAL, INC
Entity Type:Organization
Organization Name:NORTHERN HOME MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTONUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-272-9021
Mailing Address - Street 1:PO BOX 2568
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-2568
Mailing Address - Country:US
Mailing Address - Phone:530-272-9021
Mailing Address - Fax:530-272-2804
Practice Address - Street 1:930 IDAHO MARYLAND RD
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5943
Practice Address - Country:US
Practice Address - Phone:530-272-9021
Practice Address - Fax:530-272-2804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME00370GMedicaid
CA4813650001Medicare NSC