Provider Demographics
NPI:1194776146
Name:LITTLETON HOMECARE SUPPLY INC.
Entity type:Organization
Organization Name:LITTLETON HOMECARE SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEVAN
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:937-382-5694
Mailing Address - Street 1:1682 ALEX DRIVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177
Mailing Address - Country:US
Mailing Address - Phone:937-382-5694
Mailing Address - Fax:937-382-8885
Practice Address - Street 1:1682 ALEX DRIVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177
Practice Address - Country:US
Practice Address - Phone:937-382-5694
Practice Address - Fax:937-382-8885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHHMER.222050332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0441892Medicaid
OH0286270001Medicare UPIN