Provider Demographics
NPI:1588125926
Name:ABC HOME CARE SUPPLIES
Entity type:Organization
Organization Name:ABC HOME CARE SUPPLIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AKEESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKITT - PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-273-0762
Mailing Address - Street 1:12 CLARKE ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-2002
Mailing Address - Country:US
Mailing Address - Phone:631-273-0762
Mailing Address - Fax:631-273-0762
Practice Address - Street 1:12 CLARKE ST
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-2002
Practice Address - Country:US
Practice Address - Phone:631-273-0762
Practice Address - Fax:631-273-0762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition