Provider Demographics
NPI:1366646218
Name:WILBUR HOME HEALTH CARE & MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:WILBUR HOME HEALTH CARE & MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:H
Authorized Official - Last Name:HAKIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-458-1500
Mailing Address - Street 1:16023 ARROW HWY STE D
Mailing Address - Street 2:
Mailing Address - City:IRWINDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91706-2061
Mailing Address - Country:US
Mailing Address - Phone:626-458-1500
Mailing Address - Fax:626-458-1200
Practice Address - Street 1:16023 ARROW HWY STE D&E
Practice Address - Street 2:
Practice Address - City:IRWINDALE
Practice Address - State:CA
Practice Address - Zip Code:91706-2061
Practice Address - Country:US
Practice Address - Phone:626-458-1500
Practice Address - Fax:626-458-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55591332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2846138Medicaid
CA800696229Medicaid
CADME03319FMedicaid