Healthcare Provider Details

I. General information

NPI: 1285636357
Provider Name (Legal Business Name): FAYETTE HOME HEALTH CARE SUPPLY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 W COURT ST
WASHINGTON COURT HOUSE OH
43160-1326
US

IV. Provider business mailing address

1100 HATCHER LN
COLUMBIA TN
38401-3530
US

V. Phone/Fax

Practice location:
  • Phone: 740-636-0720
  • Fax:
Mailing address:
  • Phone: 740-636-0720
  • Fax: 740-636-0780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAVID BAXTER
Title or Position: OWNER
Credential:
Phone: 931-375-1775