Healthcare Provider Details

I. General information

NPI: 1114920410
Provider Name (Legal Business Name): HOME AGAIN OXYGEN AND MOBILITY PRODUCTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 06/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25270 BERNWOOD DR UNIT 5
BONITA SPRINGS FL
34135-7897
US

IV. Provider business mailing address

25270 BERNWOOD DR UNIT 5
BONITA SPRINGS FL
34135-7897
US

V. Phone/Fax

Practice location:
  • Phone: 239-390-1077
  • Fax: 239-390-0444
Mailing address:
  • Phone: 239-390-1077
  • Fax: 239-390-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1651
License Number StateFL

VIII. Authorized Official

Name: MR. RICHARD G HEADLEY
Title or Position: OWNER
Credential:
Phone: 239-390-1077