Provider Demographics
NPI:1598919169
Name:SWEET CARE MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:SWEET CARE MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANUSHAVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SARGSYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-254-3800
Mailing Address - Street 1:5689 YORK BLVD
Mailing Address - Street 2:SUIT B
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-2550
Mailing Address - Country:US
Mailing Address - Phone:323-254-3800
Mailing Address - Fax:323-254-3801
Practice Address - Street 1:5689 YORK BLVD
Practice Address - Street 2:SUIT B
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-2550
Practice Address - Country:US
Practice Address - Phone:323-254-3800
Practice Address - Fax:323-254-3801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000238735800015332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6369060001Medicare NSC