Organization
HOMEDIC INC
Active
Other names
Homedic Respiratory
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARIE VERONICA FENTRESS (DIRECTOR OF OPERATIONS)
(909) 422-1112
Entity
Organization
Contact information
Practice address
671 E COOLEY DRIVE # 104, COLTON, CA 92324
(909) 422-1121
(909) 422-1191
Mailing address
671 E COOLEY DRIVE # 104, PO BOX 1344, COLTON, CA 92324
(909) 422-1121
(909) 422-1191
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DME01319G
—
CA
Enumeration date
11/28/2006
Last updated
03/04/2008
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