Provider Demographics
NPI:1376093567
Name:MY HOME MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:MY HOME MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-921-1054
Mailing Address - Street 1:4700 NORTHGATE BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1147
Mailing Address - Country:US
Mailing Address - Phone:916-921-1054
Mailing Address - Fax:916-943-1633
Practice Address - Street 1:4700 NORTHGATE BLVD STE 160
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1147
Practice Address - Country:US
Practice Address - Phone:916-921-1054
Practice Address - Fax:916-943-1633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76536332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies