Provider Demographics
NPI:1659422418
Name:AT HOME MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:AT HOME MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ORALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-964-7593
Mailing Address - Street 1:539 VIA RUEDA
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-2041
Mailing Address - Country:US
Mailing Address - Phone:805-964-7593
Mailing Address - Fax:805-964-7593
Practice Address - Street 1:539 VIA RUEDA
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-2041
Practice Address - Country:US
Practice Address - Phone:805-964-7593
Practice Address - Fax:805-964-7593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103766332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5257380001Medicare ID - Type Unspecified