Healthcare Provider Details

I. General information

NPI: 1578207593
Provider Name (Legal Business Name): ONE HOME MEDICAL EQUIPMENT VA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 04/26/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4905 CROWE DRIVE
MOUNT CRAWFORD VA
22841
US

IV. Provider business mailing address

3351 EXECUTIVE WAY
MIRAMAR FL
33025-3935
US

V. Phone/Fax

Practice location:
  • Phone: 855-441-6900
  • Fax: 855-441-6941
Mailing address:
  • Phone: 786-234-9095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RYAN COCHRAN
Title or Position: CFO
Credential:
Phone: 786-234-9095