Provider Demographics
NPI:1902880271
Name:AMERICAN HOME CARE SUPPLY COMPANY, INC.
Entity Type:Organization
Organization Name:AMERICAN HOME CARE SUPPLY COMPANY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:PARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-961-0155
Mailing Address - Street 1:4113 BIRNEY AVE
Mailing Address - Street 2:
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18507-1301
Mailing Address - Country:US
Mailing Address - Phone:570-961-0155
Mailing Address - Fax:570-961-1802
Practice Address - Street 1:38 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:PA
Practice Address - Zip Code:16933-1422
Practice Address - Country:US
Practice Address - Phone:570-662-7001
Practice Address - Fax:570-662-7229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
PA3000007528332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00016726890006Medicaid
1196210004Medicare ID - Type Unspecified