Organization
HOME HEALTH DEPOT INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERRI GOLDMAN (DIRECTOR OF CONTRACTING)
(317) 333-6033
Entity
Organization
Contact information
Practice address
2228 SAGAMORE PKWY S, SUITE B, LAFAYETTE, IN 47905-5112
(765) 807-5628
(765) 807-5640
Mailing address
9245 N MERIDIAN ST, SUITE 200, INDIANAPOLIS, IN 46260-1836
(317) 333-6033
(317) 333-6034
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
69000636A
IN
332BC3200X
Customized Equipment (DME)
69000636A
IN
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
69000636A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200206500E
—
IN
Enumeration date
10/31/2010
Last updated
05/13/2015
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