Provider Demographics
NPI:1689776619
Name:ADVANCED HOME CARE MEDICAL SUPPLY
Entity Type:Organization
Organization Name:ADVANCED HOME CARE MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:AFAHA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:714-889-7071
Mailing Address - Street 1:7659 GARDEN GROVE BLVD
Mailing Address - Street 2:P.O BOX 53 TUSTIN CA 92781
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-4206
Mailing Address - Country:US
Mailing Address - Phone:714-889-7071
Mailing Address - Fax:714-889-7087
Practice Address - Street 1:7659 GARDEN GROVE BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-4206
Practice Address - Country:US
Practice Address - Phone:714-889-7071
Practice Address - Fax:714-889-7087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1208340001Medicare ID - Type Unspecified