Provider Demographics
NPI:1730227158
Name:HOMELINE INC
Entity type:Organization
Organization Name:HOMELINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHIRISH
Authorized Official - Middle Name:N
Authorized Official - Last Name:MODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-491-1851
Mailing Address - Street 1:9625 BLACK MOUNTAIN RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4564
Mailing Address - Country:US
Mailing Address - Phone:800-644-2558
Mailing Address - Fax:877-365-1937
Practice Address - Street 1:9625 BLACK MOUNTAIN RD
Practice Address - Street 2:SUITE 302
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4564
Practice Address - Country:US
Practice Address - Phone:800-644-2558
Practice Address - Fax:877-365-1937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1267670001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1267670001Medicare ID - Type Unspecified