Provider Demographics
NPI:1417116773
Name:VAN NESS HEALTH CARE INC.
Entity Type:Organization
Organization Name:VAN NESS HEALTH CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-292-3558
Mailing Address - Street 1:4369 S VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90062-1454
Mailing Address - Country:US
Mailing Address - Phone:323-292-3558
Mailing Address - Fax:323-292-3688
Practice Address - Street 1:4369 S VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90062-1454
Practice Address - Country:US
Practice Address - Phone:323-292-3558
Practice Address - Fax:323-292-3688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0002030788-0001-0332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6316010001Medicare NSC