Healthcare Provider Details

I. General information

NPI: 1730227158
Provider Name (Legal Business Name): HOMELINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9625 BLACK MOUNTAIN RD SUITE 302
SAN DIEGO CA
92126-4564
US

IV. Provider business mailing address

9625 BLACK MOUNTAIN RD SUITE 302
SAN DIEGO CA
92126-4564
US

V. Phone/Fax

Practice location:
  • Phone: 800-644-2558
  • Fax: 877-365-1937
Mailing address:
  • Phone: 800-644-2558
  • Fax: 877-365-1937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1267670001
License Number StateKY

VIII. Authorized Official

Name: MR. SHIRISH N MODY
Title or Position: OWNER
Credential:
Phone: 502-491-1851