Provider Demographics
NPI:1629381207
Name:A HOMECARE DEVICE, INC.
Entity Type:Organization
Organization Name:A HOMECARE DEVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:VARTAN
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:GUKASYAN
Authorized Official - Suffix:
Authorized Official - Credentials:ATP, OT, EXEMPTEE
Authorized Official - Phone:310-537-9977
Mailing Address - Street 1:PO BOX 21071
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91221-5171
Mailing Address - Country:US
Mailing Address - Phone:310-537-9977
Mailing Address - Fax:323-693-1878
Practice Address - Street 1:3737 MARTIN LUTHER KING JR BLVD STE 106
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-3524
Practice Address - Country:US
Practice Address - Phone:310-537-9977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies