Provider Demographics
NPI:1376723221
Name:SENIOR VILLAS DME INC
Entity Type:Organization
Organization Name:SENIOR VILLAS DME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESEDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARNIK
Authorized Official - Middle Name:
Authorized Official - Last Name:EKMEKCHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-462-4030
Mailing Address - Street 1:5007 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-4106
Mailing Address - Country:US
Mailing Address - Phone:323-462-4030
Mailing Address - Fax:323-462-4031
Practice Address - Street 1:5007 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038-4106
Practice Address - Country:US
Practice Address - Phone:323-462-4030
Practice Address - Fax:323-462-4031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000224932000011332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6085550001Medicare NSC