Healthcare Provider Details

I. General information

NPI: 1427241785
Provider Name (Legal Business Name): HOSPITAL DRIVE HOMECARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4113 BIRNEY AVE
MOOSIC PA
18507-1301
US

IV. Provider business mailing address

9 BECKETT CLOSE
MOOSIC PA
18507-1929
US

V. Phone/Fax

Practice location:
  • Phone: 570-348-9442
  • Fax:
Mailing address:
  • Phone: 570-348-9442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number3000008176
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number3000008176
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number3000008176
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number3000008176
License Number StatePA

VIII. Authorized Official

Name: RICHARD L PARA
Title or Position: PRESIDENT
Credential:
Phone: 570-963-0744