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General NPI Number Information
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NPI Number | 1740356807
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Entity Type | Organization
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Legal Business Name | HOMEDIC INC
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 03/04/2008
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Provider Practice Location Address
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Address Line | 671 E COOLEY DRIVE # 104
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City | COLTON
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State | CA
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Zip | 92324
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Country | US
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Telephone | 909-422-1121
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Fax | 909-422-1191
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Provider Business Mailing Address
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Address Line | 671 E COOLEY DRIVE # 104 PO BOX 1344
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City | COLTON
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State | CA
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Zip | 92324
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Country | US
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Telephone | 909-422-1121
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Fax | 909-422-1191
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MRS. MARIE VERONICA FENTRESS
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Credential |
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Telephone | 909-422-1112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #2
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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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