Healthcare Provider Details

I. General information

NPI: 1255341145
Provider Name (Legal Business Name): DICKS HOME CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 N LOGAN BLVD STE 8
BURNHAM PA
17009-1819
US

IV. Provider business mailing address

401 MAPLE AVE
ALTOONA PA
16601-4170
US

V. Phone/Fax

Practice location:
  • Phone: 717-247-0445
  • Fax: 717-247-0447
Mailing address:
  • Phone: 814-949-6764
  • Fax: 814-949-6767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier39HA34
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCAPITAL BLUE CROSS
# 2
Identifier1007550730006
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 3
Identifier232694
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK

VIII. Authorized Official

Name: MR. RANDY EDWARD DICK
Title or Position: PRESIDENT
Credential:
Phone: 814-949-6764