Healthcare Provider Details

I. General information

NPI: 1578645446
Provider Name (Legal Business Name): AT HOME HEALTH EQUIPMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4309 W 96TH ST
INDIANAPOLIS IN
46268-1115
US

IV. Provider business mailing address

1019 TOWN DR
HIGHLAND HEIGHTS KY
41076-9114
US

V. Phone/Fax

Practice location:
  • Phone: 317-872-9702
  • Fax: 317-872-9704
Mailing address:
  • Phone: 859-441-8876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number69000078A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number69000078A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number69000078A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number69000078A
License Number StateIN

VIII. Authorized Official

Name: GREGORY J CRAWFORD
Title or Position: CEO
Credential:
Phone: 859-441-8876