Healthcare Provider Details

I. General information

NPI: 1538469051
Provider Name (Legal Business Name): HOME HEALTH DEPOT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2010
Last Update Date: 05/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2228 SAGAMORE PKWY S SUITE B
LAFAYETTE IN
47905-5112
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 765-807-5628
  • Fax: 765-807-5640
Mailing address:
  • Phone: 317-333-6033
  • Fax: 317-333-6034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number69000636A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number69000636A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number69000636A
License Number StateIN

VIII. Authorized Official

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