Provider Demographics
NPI:1689766602
Name:HOME HEALTH SUPPLY, INC.
Entity Type:Organization
Organization Name:HOME HEALTH SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUBIN
Authorized Official - Suffix:II
Authorized Official - Credentials:ATP/S, CRTS
Authorized Official - Phone:760-327-3378
Mailing Address - Street 1:820 E RESEARCH DR STE 4
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-5945
Mailing Address - Country:US
Mailing Address - Phone:760-327-3378
Mailing Address - Fax:760-327-7365
Practice Address - Street 1:820 E RESEARCH DR STE 4
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-5945
Practice Address - Country:US
Practice Address - Phone:760-327-3378
Practice Address - Fax:760-327-7365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103473332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME00750FMedicaid
CA0488560001Medicare NSC