Provider Demographics
NPI:1033931696
Name:ABC HOME MEDICAL SUPPLY, INC.
Entity type:Organization
Organization Name:ABC HOME MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:M
Authorized Official - Last Name:VESTAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-897-8588
Mailing Address - Street 1:PO BOX 674553
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-4553
Mailing Address - Country:US
Mailing Address - Phone:866-897-8588
Mailing Address - Fax:877-785-7396
Practice Address - Street 1:1501 N UNIVERSITY AVE STE 370
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-5232
Practice Address - Country:US
Practice Address - Phone:501-260-8884
Practice Address - Fax:877-785-7396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-25
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR337857716Medicaid