Provider Demographics
NPI:1871738153
Name:HOMETOWN OXYGEN CHARLOTTE LLC
Entity type:Organization
Organization Name:HOMETOWN OXYGEN CHARLOTTE LLC
Other - Org Name:<UNAVAIL>
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 1:41 SPRING ST.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974
Mailing Address - Country:US
Mailing Address - Phone:704-782-0222
Mailing Address - Fax:704-784-0055
Practice Address - Street 1:369 CONCORD PKWY N
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-6734
Practice Address - Country:US
Practice Address - Phone:704-782-0222
Practice Address - Fax:704-784-0055
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOMETOWN OXYGEN CHARLOTTE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-15
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01452332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5663650002Medicare NSC