Provider Demographics
NPI:1427174218
Name:AT HOME SUPPLIES
Entity type:Organization
Organization Name:AT HOME SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GRAGG
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:918-760-1122
Mailing Address - Street 1:PO BOX 481
Mailing Address - Street 2:
Mailing Address - City:MANNFORD
Mailing Address - State:OK
Mailing Address - Zip Code:74044-0481
Mailing Address - Country:US
Mailing Address - Phone:918-760-1122
Mailing Address - Fax:918-865-2558
Practice Address - Street 1:177 GRANADA DRIVE
Practice Address - Street 2:
Practice Address - City:MANNFORD
Practice Address - State:OK
Practice Address - Zip Code:74044
Practice Address - Country:US
Practice Address - Phone:918-760-1122
Practice Address - Fax:918-865-2558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies