Organization
HOME HEALTH DEPOT INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRI GOLDMAN (DIRECTOR OF CONTRACTING)
(317) 333-6033
Entity
Organization
Contact information
Practice address
105 KRISPY KREME DR, SUITE 3, BLOOMINGTON, IL 61704-3751
(309) 662-4606
(309) 663-1916
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
Primary
203.001290
IL
332BC3200X
Customized Equipment (DME)
203.001290
IL
332BX2000X
Oxygen Equipment & Supplies (DME)
203.001290
IL
Other
Enumeration date
11/08/2010
Last updated
01/09/2012
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