Provider Demographics
NPI:1366441909
Name:CHOICE HOME MEDICAL SUPPLIES, INC.
Entity Type:Organization
Organization Name:CHOICE HOME MEDICAL SUPPLIES, INC.
Other - Org Name:CHOICE MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-865-2814
Mailing Address - Street 1:800 E WARDLOW RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4651
Mailing Address - Country:US
Mailing Address - Phone:562-256-9961
Mailing Address - Fax:562-256-9981
Practice Address - Street 1:800 E WARDLOW RD
Practice Address - Street 2:SUITE A
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4651
Practice Address - Country:US
Practice Address - Phone:562-256-9961
Practice Address - Fax:562-256-9981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47494332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA47494OtherHOME MEDICAL DEVICE RETAI
CAZZZ09377ZOtherBLUE SHIELD OF CA PROV #
CADME03187FMedicaid
CA5289880001Medicare ID - Type UnspecifiedMEDICARE PROVIDER #