Healthcare Provider Details

I. General information

NPI: 1942468699
Provider Name (Legal Business Name): HOME RX, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4906 AMBASSADOR CAFFERY PKWY BUILDING A, SUITE1
LAFAYETTE LA
70508-6962
US

IV. Provider business mailing address

4906 AMBASSADOR CAFFERY PKWY BUILDING A, SUITE1
LAFAYETTE LA
70508-6962
US

V. Phone/Fax

Practice location:
  • Phone: 337-234-1292
  • Fax: 337-235-4555
Mailing address:
  • Phone: 337-234-1292
  • Fax: 337-235-4555

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 Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH G KINGSTON
Title or Position: VICE PRESIDENT
Credential: P.D.
Phone: 337-234-1292