Provider Demographics
NPI:1235375916
Name:JEHOVAH-JIREH MEDICAL SUPPLIES INC.
Entity Type:Organization
Organization Name:JEHOVAH-JIREH MEDICAL SUPPLIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:OLUSEGUN
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:SALAMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-594-0043
Mailing Address - Street 1:14607 1/2 PRAIRIE AVENUE
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-1830
Mailing Address - Country:US
Mailing Address - Phone:310-970-0044
Mailing Address - Fax:310-970-0040
Practice Address - Street 1:14607 1/2 PRAIRIE AVENUE
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1830
Practice Address - Country:US
Practice Address - Phone:310-970-0044
Practice Address - Fax:310-970-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-30
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6330650001Medicare NSC