Provider Demographics
NPI:1275522310
Name:YESNACO HEALTH SERVICE
Entity Type:Organization
Organization Name:YESNACO HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NII
Authorized Official - Middle Name:AHUMA
Authorized Official - Last Name:OCANSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-733-7338
Mailing Address - Street 1:PO BOX 352257
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-0258
Mailing Address - Country:US
Mailing Address - Phone:323-733-7338
Mailing Address - Fax:323-733-7309
Practice Address - Street 1:4809 W ADAMS BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-2820
Practice Address - Country:US
Practice Address - Phone:323-733-7338
Practice Address - Fax:323-733-7309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4122140001Medicare ID - Type Unspecified