MEDICARE: HUNTLEIGH AT HOME

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	332BX2000X	Oxygen Equipment & Supplies (DME)		TX

General Provider Information

NPI Number	:	1457492134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUNTLEIGH AT HOME

Provider Business Mailing Address
First Line	:	5024 BROADWAY ST
Second Line	:	HUNTLEIGH AT HOME
City	:	ALAMO HEIGHTS
State	:	TX
Zip	:	78209-5708
Country	:	US
Telephone Number	:	210-826-6969
Fax Number	:	210-826-6967

Provider Business Practice Location Address
First Line	:	5024 BROADWAY ST
Second Line	:	HUNTLEIGH AT HOME
City	:	ALAMO HEIGHTS
State	:	TX
Zip	:	78209-5708
Country	:	US
Telephone Number	:	210-826-6969
Fax Number	:	210-826-6967

Authorized Official
Title or Position	:	VP OF THE GENERAL MANAGER
Name	:	MR. MICHAEL D FLORES
Credential	:
Telephone Number	:	210-225-7400

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	08/22/2020

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