1255471744 NPI number — HOMECARE MEDICAL PRODUCTS INC

Table of content: (NPI 1255471744)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255471744 NPI number — HOMECARE MEDICAL PRODUCTS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOMECARE MEDICAL PRODUCTS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMFORTCARE HEARING AID CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255471744
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5220 SANTA MONICA BLVD STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90029-1234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-666-0414
Provider Business Mailing Address Fax Number:
323-913-4138

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15823 MONTE ST STE E106
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYLMAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91342-7675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-666-0414
Provider Business Practice Location Address Fax Number:
323-913-4138
Provider Enumeration Date:
02/07/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KAVOUKJIAN
Authorized Official First Name:
HAIKOUHI
Authorized Official Middle Name:
HEIDI
Authorized Official Title or Position:
VP/SECRETARY
Authorized Official Telephone Number:
323-666-0414

Provider Taxonomy Codes

  • Taxonomy code: 332S00000X , with the licence number:  HA2983 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HA0029830 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".