Healthcare Provider Details

I. General information

NPI: 1487824561
Provider Name (Legal Business Name): DMR HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 01/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 E TANGER DR SUITE 109
CASA GRANDE AZ
85122-9608
US

IV. Provider business mailing address

2300 E TANGER DR STE 109
CASA GRANDE AZ
85122-9630
US

V. Phone/Fax

Practice location:
  • Phone: 520-494-9990
  • Fax: 520-494-9122
Mailing address:
  • Phone: 520-494-9990
  • Fax: 520-494-9122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number20262380
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberC000764
License Number StateAZ

VIII. Authorized Official

Name: MR. DANIEL DEAN FOSTER
Title or Position: OWNER
Credential:
Phone: 520-494-9990