Provider Demographics
NPI:1598597932
Name:HOMETOWN OXYGEN, CHARLOTTE LLC
Entity type:Organization
Organization Name:HOMETOWN OXYGEN, CHARLOTTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LARIVIERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-776-6782
Mailing Address - Street 1:369 CONCORD PKWY N
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-6734
Mailing Address - Country:US
Mailing Address - Phone:866-776-6782
Mailing Address - Fax:
Practice Address - Street 1:1370 OLD SALISBURY RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-5640
Practice Address - Country:US
Practice Address - Phone:888-902-3502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOMETOWN OXYGEN, CHARLOTTE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies