Healthcare Provider Details

I. General information

NPI: 1164723722
Provider Name (Legal Business Name): HOME HEALTH DEPOT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2010
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7717 KENSINGTON CT
BRIGHTON MI
48116-8561
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 248-264-7099
  • Fax: 248-264-7097
Mailing address:
  • Phone: 317-333-6033
  • Fax: 317-333-6034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMI

VIII. Authorized Official

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