Provider Demographics
NPI:1386778595
Name:IV AT HOME INC.
Entity type:Organization
Organization Name:IV AT HOME INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRISHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-562-7007
Mailing Address - Street 1:119 WARD ST S
Mailing Address - Street 2:
Mailing Address - City:SENATOBIA
Mailing Address - State:MS
Mailing Address - Zip Code:38668-2638
Mailing Address - Country:US
Mailing Address - Phone:662-562-7007
Mailing Address - Fax:662-562-8009
Practice Address - Street 1:119 WARD ST S
Practice Address - Street 2:
Practice Address - City:SENATOBIA
Practice Address - State:MS
Practice Address - Zip Code:38668-2638
Practice Address - Country:US
Practice Address - Phone:662-562-7007
Practice Address - Fax:662-562-8009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0409111.1332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00440159Medicaid
MS00440159Medicaid