Healthcare Provider Details

I. General information

NPI: 1760757934
Provider Name (Legal Business Name): ABC HOME MEDICAL SUPPLY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 INTERPLEX DR STE 201
FEASTERVILLE TREVOSE PA
19053-6968
US

IV. Provider business mailing address

PO BOX 674553
DETROIT MI
48267-4553
US

V. Phone/Fax

Practice location:
  • Phone: 267-982-4489
  • Fax: 610-363-1009
Mailing address:
  • Phone: 866-879-8588
  • Fax: 877-785-7396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

# 1
Identifier1015431740007
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier250696458
Identifier TypeMEDICAID
Identifier StateDE
Identifier Issuer
# 3
Identifier0742465
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: EMILY M VESTAL
Title or Position: PRESIDENT AND DIRECTOR
Credential:
Phone: 866-897-8588