Provider Demographics
NPI:1659305969
Name:GREATER HEALTH MEDICAL SUPPLY
Entity Type:Organization
Organization Name:GREATER HEALTH MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADEOYE
Authorized Official - Middle Name:MOSES
Authorized Official - Last Name:OGUNLADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-787-1731
Mailing Address - Street 1:2204 TORRANCE BLVD
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-2544
Mailing Address - Country:US
Mailing Address - Phone:310-787-1731
Mailing Address - Fax:310-787-1771
Practice Address - Street 1:2204 TORRANCE BLVD
Practice Address - Street 2:SUITE 101B
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-2544
Practice Address - Country:US
Practice Address - Phone:310-787-1731
Practice Address - Fax:310-787-1771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5413670001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME03376FMedicaid
CA5413670001Medicare ID - Type UnspecifiedPROVIDER NUMBER