Provider Demographics
NPI:1568799096
Name:TOTALCARE MEDICAL SUPPLY & SERVICES
Entity Type:Organization
Organization Name:TOTALCARE MEDICAL SUPPLY & SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLADOKUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-941-4000
Mailing Address - Street 1:7365 CARNELIAN ST
Mailing Address - Street 2:STE 112
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1158
Mailing Address - Country:US
Mailing Address - Phone:909-941-4000
Mailing Address - Fax:909-941-4001
Practice Address - Street 1:7365 CARNELIAN ST
Practice Address - Street 2:STE 112
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1158
Practice Address - Country:US
Practice Address - Phone:909-941-4000
Practice Address - Fax:909-941-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52753332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6429030001Medicare NSC