Healthcare Provider Details

I. General information

NPI: 1720162977
Provider Name (Legal Business Name): CONVALESCENT HOME EQUIPMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3002 FALLS RD
TOCCOA GA
30577-1401
US

IV. Provider business mailing address

PO BOX 116
TOCCOA GA
30577-1401
US

V. Phone/Fax

Practice location:
  • Phone: 706-886-8474
  • Fax: 706-886-7032
Mailing address:
  • Phone: 706-886-8474
  • Fax: 706-886-7032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ANN W JAMES
Title or Position: CSR
Credential:
Phone: 706-886-8474