1275587685 NPI number — ADVANCED HOME MEDICAL INC

Table of content: (NPI 1275587685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275587685 NPI number — ADVANCED HOME MEDICAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED HOME MEDICAL 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:
Provider Other Organization Name Type Code:
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:
1275587685
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23785 CANYON VISTA CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DIAMOND BAR
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91765-6116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-861-4871
Provider Business Mailing Address Fax Number:
909-444-5503

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
312 PASEO TESORO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALNUT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91789-2725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-444-2991
Provider Business Practice Location Address Fax Number:
909-444-5503
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REAL
Authorized Official First Name:
YEA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANGAER
Authorized Official Telephone Number:
909-444-2991

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: DME02989G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9052838 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1275587685 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000633900 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200282740A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 874736565 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90006339 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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