Healthcare Provider Details

I. General information

NPI: 1346269578
Provider Name (Legal Business Name): AMERICAN HOME CARE SUPPLY COMPANY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 04/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 JEFFERSON AVE
SCRANTON PA
18510-1038
US

IV. Provider business mailing address

4113 BIRNEY AVE
MOOSIC PA
18507-1330
US

V. Phone/Fax

Practice location:
  • Phone: 570-341-9002
  • Fax: 570-341-9535
Mailing address:
  • Phone: 570-961-0155
  • Fax: 570-961-1802

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
Identifier0016726890007
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MR. RICHARD L PARA
Title or Position: PRESIDENT
Credential:
Phone: 570-961-0155