Provider Demographics
NPI:1588716427
Name:HOMELIFE OXYGEN, LLC
Entity type:Organization
Organization Name:HOMELIFE OXYGEN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:FOUST
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:901-373-3503
Mailing Address - Street 1:1675 N SHELBY OAKS DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-7430
Mailing Address - Country:US
Mailing Address - Phone:901-373-3503
Mailing Address - Fax:901-372-3610
Practice Address - Street 1:1675 N SHELBY OAKS DR
Practice Address - Street 2:SUITE 2
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-7430
Practice Address - Country:US
Practice Address - Phone:901-373-3503
Practice Address - Fax:901-372-3610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3978333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0440365Medicaid
TN1452198Medicaid
TN3016454OtherBLUE CROSS BLUE SHIELD
TN=========OtherALL OTHER INSURANCES
TN=========OtherALL OTHER INSURANCES