Provider Demographics
NPI:1386638104
Name:HOMECARE SERVICE SPECIALIST INC
Entity Type:Organization
Organization Name:HOMECARE SERVICE SPECIALIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FELITO
Authorized Official - Middle Name:FLORES
Authorized Official - Last Name:DE VEYRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-265-0424
Mailing Address - Street 1:328 N ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2206
Mailing Address - Country:US
Mailing Address - Phone:818-265-0424
Mailing Address - Fax:818-265-0420
Practice Address - Street 1:328 N ORANGE ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2206
Practice Address - Country:US
Practice Address - Phone:818-265-0424
Practice Address - Fax:818-265-0420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME01593FMedicaid
CADME01593FMedicaid