Provider Demographics
NPI:1528086477
Name:HOME PRIDE MEDICAL SUPPLY CO.
Entity type:Organization
Organization Name:HOME PRIDE MEDICAL SUPPLY CO.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:EJIOFOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-212-9133
Mailing Address - Street 1:1221 CORPORATION PKWY
Mailing Address - Street 2:119
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1392
Mailing Address - Country:US
Mailing Address - Phone:919-212-9133
Mailing Address - Fax:919-212-3094
Practice Address - Street 1:1221 CORPORATION PKWY
Practice Address - Street 2:119
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1392
Practice Address - Country:US
Practice Address - Phone:919-212-9133
Practice Address - Fax:919-212-3094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00883332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7704369Medicaid
NC4991030003Medicare ID - Type Unspecified