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General NPI Number Information
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NPI Number | 1215244207
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Entity Type | Organization
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Legal Business Name | AT HOME DURABLE MEDICAL EQUIPMENT
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Dates
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Enumeration Date | 09/12/2010
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Last Update Date | 09/15/2010
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Provider Practice Location Address
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Address Line | 9005 N MILE 4 W
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City | MERCEDES
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State | TX
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Zip | 78570-5713
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Country | US
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Telephone | 956-638-1078
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Fax | 956-969-5728
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Provider Business Mailing Address
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Address Line | 2720 N WESTGATE DR
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City | WESLACO
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State | TX
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Zip | 78596-3875
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Country | US
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Telephone | 956-638-1078
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Fax | 956-969-5728
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS CYNTHIA SUSTAITA
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Credential | CFO
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Telephone | 956-638-1078
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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 |
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