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General NPI Number Information
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NPI Number | 1043411705
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Entity Type | Organization
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Legal Business Name | ON THE GO HME, INC.
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 03/15/2008
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Provider Practice Location Address
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Address Line | 2201 W BROADWAY BAY #4
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51501-3605
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Country | US
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Telephone | 712-256-9595
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Fax | 712-256-9596
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Provider Business Mailing Address
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Address Line | 2201 W BROADWAY BAY #4
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51501-3605
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Country | US
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Telephone | 712-256-9595
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Fax | 712-256-9596
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Authorized Official
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Title or Position | OWNER
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Name | DAWN ELISE ALLMON
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Credential | B.A.
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Telephone | 712-256-9595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | IA
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