Healthcare Provider Details

I. General information

NPI: 1144844457
Provider Name (Legal Business Name): HOMETOWN OXYGEN CHARLOTTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7499 PARKLANE RD STE 144
COLUMBIA SC
29223-7650
US

IV. Provider business mailing address

41 SPRING ST STE 103
NEW PROVIDENCE NJ
07974-1143
US

V. Phone/Fax

Practice location:
  • Phone: 704-347-2233
  • Fax: 704-331-4702
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateNULL

VIII. Authorized Official

Name: STEPHEN A LARIVIERE
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 866-776-6782