MEDICARE: HOME CARE SUPPLY LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	332BC3200X	Customized Equipment (DME)
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
3	332BX2000X	Oxygen Equipment & Supplies (DME)
4	332B00000X	Durable Medical Equipment & Medical Supplies

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	:	1477579753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME CARE SUPPLY LLC

Provider Business Mailing Address
First Line	:	350 PINE ST
Second Line	:	SUITE 330
City	:	BEAUMONT
State	:	TX
Zip	:	77701-2437
Country	:	US
Telephone Number	:	409-951-6179
Fax Number	:	203-702-6840

Provider Business Practice Location Address
First Line	:	1830 RYAN ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-6000
Country	:	US
Telephone Number	:	337-479-0707
Fax Number	:	409-654-2068

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SCOTT KALTRIDER
Credential	:
Telephone Number	:	203-837-2330

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	09/30/2009

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