Healthcare Provider Details

I. General information

NPI: 1295079861
Provider Name (Legal Business Name): M.R.S. HOMECARE. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 HOSPITAL DRIVE STE L
WARNER ROBINS GA
31088-1232
US

IV. Provider business mailing address

PO BOX 568
ALBANY GA
31702-0568
US

V. Phone/Fax

Practice location:
  • Phone: 478-922-2889
  • Fax: 478-922-9120
Mailing address:
  • Phone: 229-439-2403
  • Fax: 229-883-8426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. E TOM RIDDLE
Title or Position: PRESIDENT
Credential:
Phone: 229-382-2002