Healthcare Provider Details

I. General information

NPI: 1912717455
Provider Name (Legal Business Name): FAMILY HOME MEDICAL EQUIPMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4994 LOWER ROSWELL RD STE 19
MARIETTA GA
30068-5648
US

IV. Provider business mailing address

6414 S 118TH ST
OMAHA NE
68137-3576
US

V. Phone/Fax

Practice location:
  • Phone: 943-207-9151
  • Fax: 943-207-9152
Mailing address:
  • Phone: 402-281-4404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRENDA VANDERPOOL
Title or Position: COMPLIANCE OFFICER
Credential:
Phone: 937-771-6501