Provider Demographics
NPI:1588911911
Name:HOMME, GREGGREY
Entity type:Individual
Prefix:
First Name:GREGGREY
Middle Name:
Last Name:HOMME
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6753
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92248-6753
Mailing Address - Country:US
Mailing Address - Phone:760-777-7720
Mailing Address - Fax:760-391-6998
Practice Address - Street 1:81840 AVENUE 46 STE 201
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-3948
Practice Address - Country:US
Practice Address - Phone:760-391-6971
Practice Address - Fax:760-391-6998
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator