MEDICARE: HOME HEALTH DEPOT INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	69000965A	IN
2	332BC3200X	Customized Equipment (DME)	69000965A	IN
3	332BX2000X	Oxygen Equipment & Supplies (DME)	69000965A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093016669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME HEALTH DEPOT INC

Provider Business Mailing Address
First Line	:	9245 N MERIDIAN ST
Second Line	:	SUITE 200
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1836
Country	:	US
Telephone Number	:	317-333-6033
Fax Number	:	317-333-6034

Provider Business Practice Location Address
First Line	:	6004 HIGHVIEW DR
Second Line	:	SUITE A
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-1383
Country	:	US
Telephone Number	:	260-399-1355
Fax Number	:	260-399-1344

Authorized Official
Title or Position	:	CEO
Name	:	DAVID A HARTLEY JR.
Credential	:
Telephone Number	:	317-333-6033

Provider Enumeration Date	:	11/12/2010
Last Update Date	:	06/08/2012

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Directions to “HOME HEALTH DEPOT INC ” Practice Location

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