Provider Demographics
NPI:1689682866
Name:RESIDENTIAL MEDICAL SUPPLY SERVICES
Entity Type:Organization
Organization Name:RESIDENTIAL MEDICAL SUPPLY SERVICES
Other - Org Name:RESIDENTIAL MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:LEE KELLY
Authorized Official - Last Name:SEABORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-553-9159
Mailing Address - Street 1:7200 BANCROFT AVE
Mailing Address - Street 2:SUITE 128
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2403
Mailing Address - Country:US
Mailing Address - Phone:510-553-9159
Mailing Address - Fax:510-553-9256
Practice Address - Street 1:7200 BANCROFT AVE
Practice Address - Street 2:SUITE 128
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2403
Practice Address - Country:US
Practice Address - Phone:510-553-9159
Practice Address - Fax:510-553-9256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1232010332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9480431Medicaid
CA9480431Medicaid