Provider Demographics
NPI:1194097642
Name:FULLER HOME SOLUTIONS LLC.
Entity type:Organization
Organization Name:FULLER HOME SOLUTIONS LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:DAN
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:731-225-8221
Mailing Address - Street 1:4079 CHRISTMASVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:TN
Mailing Address - Zip Code:38355-7634
Mailing Address - Country:US
Mailing Address - Phone:731-225-8221
Mailing Address - Fax:
Practice Address - Street 1:91 MILAN HIGHWAY
Practice Address - Street 2:SUITE D
Practice Address - City:MEDINA
Practice Address - State:TN
Practice Address - Zip Code:38355
Practice Address - Country:US
Practice Address - Phone:731-225-8221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN676558332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies