Provider Demographics
NPI:1215911581
Name:AMERICAN HOMECARE SUPPLY CO
Entity type:Organization
Organization Name:AMERICAN HOMECARE SUPPLY CO
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:PARRA
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 1:150 MUNDY ST
Practice Address - Street 2:MAC IV BUILDING
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6830
Practice Address - Country:US
Practice Address - Phone:570-825-7600
Practice Address - Fax:570-825-7640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
PA3000007810332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016726890009Medicaid
PA1196210006Medicare NSC