Healthcare Provider Details

I. General information

NPI: 1457423634
Provider Name (Legal Business Name): HOMESIDE HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 US 68 SOUTHGATE PLAZA
MAYSVILLE KY
41056-9132
US

IV. Provider business mailing address

1315 US 68
MAYSVILLE KY
41056-9132
US

V. Phone/Fax

Practice location:
  • Phone: 606-563-9400
  • Fax: 606-564-4144
Mailing address:
  • Phone: 606-563-9400
  • Fax: 606-564-4144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDREW W WOOD
Title or Position: PRESIDENT
Credential:
Phone: 606-563-9400