Provider Demographics
NPI:1134305972
Name:A HOMECARE DEVICE INC
Entity Type:Organization
Organization Name:A HOMECARE DEVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHOUSHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUKASYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-757-9797
Mailing Address - Street 1:PO BOX 21071
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91221-5171
Mailing Address - Country:US
Mailing Address - Phone:800-757-9797
Mailing Address - Fax:818-767-1781
Practice Address - Street 1:5739 YORK BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-2643
Practice Address - Country:US
Practice Address - Phone:800-757-9797
Practice Address - Fax:323-693-1878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHMDR48741332BP3500X, 332BX2000X, 335E00000X
CA59017332BP3500X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME03085FMedicaid
CADME03085FMedicaid