Healthcare Provider Details

I. General information

NPI: 1780663823
Provider Name (Legal Business Name): ALICK'S HOME MEDICAL EQUIPMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17187 STATE ROAD 23
SOUTH BEND IN
46635-1521
US

IV. Provider business mailing address

17187 STATE ROAD 23
SOUTH BEND IN
46635-1521
US

V. Phone/Fax

Practice location:
  • Phone: 574-273-6000
  • Fax: 574-247-8199
Mailing address:
  • Phone: 574-273-6000
  • Fax: 574-247-8199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. NAFE STEVEN ALICK
Title or Position: PRESIDENT
Credential:
Phone: 574-273-6000