Provider Demographics
NPI:1285210427
Name:IVEDCO, LLC
Entity Type:Organization
Organization Name:IVEDCO, LLC
Other - Org Name:KABAFUSION HH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SOHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MASOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:800-435-3020
Mailing Address - Street 1:17777 CENTER COURT DR N STE 550
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-9337
Mailing Address - Country:US
Mailing Address - Phone:800-435-3020
Mailing Address - Fax:
Practice Address - Street 1:317 LILAC DR STE 100
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-7210
Practice Address - Country:US
Practice Address - Phone:405-494-2858
Practice Address - Fax:405-679-3879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-18
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health