Provider Demographics
NPI:1285678524
Name:EASY LIVING HOME HEALTHCARE SUPPLIES
Entity Type:Organization
Organization Name:EASY LIVING HOME HEALTHCARE SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:UCHE
Authorized Official - Last Name:IHENACHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-885-1015
Mailing Address - Street 1:1481 N WATERMAN AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-5329
Mailing Address - Country:US
Mailing Address - Phone:909-885-1015
Mailing Address - Fax:909-885-1283
Practice Address - Street 1:1481 N WATERMAN AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-5329
Practice Address - Country:US
Practice Address - Phone:909-885-1015
Practice Address - Fax:909-885-1015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44392332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5572060001Medicare ID - Type Unspecified