Healthcare Provider Details

I. General information

NPI: 1639479140
Provider Name (Legal Business Name): HOME HEALTH DEPOT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2010
Last Update Date: 10/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 WESTPORT CT UNIT B
BLOOMINGTON IL
61704-3626
US

IV. Provider business mailing address

9245 N MERIDIAN ST SUITE 200
INDIANAPOLIS IN
46260-1836
US

V. Phone/Fax

Practice location:
  • Phone: 309-662-4000
  • Fax: 317-333-6034
Mailing address:
  • Phone: 317-333-6033
  • Fax: 317-333-6034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. TERRI GOLDMAN
Title or Position: DIRECTOR OF CONTRACTING
Credential:
Phone: 317-333-6033