Provider Demographics
NPI:1730137951
Name:NORTH AMERICAN HOME HEALTH SUPPLY
Entity Type:Organization
Organization Name:NORTH AMERICAN HOME HEALTH SUPPLY
Other - Org Name:NORTH AMERICAN PHCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VP, TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:FICHERA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:631-870-5100
Mailing Address - Street 1:PO BOX 637299
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:800-218-5604
Mailing Address - Fax:631-249-5863
Practice Address - Street 1:16129 COHASSET ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-2908
Practice Address - Country:US
Practice Address - Phone:818-782-3757
Practice Address - Fax:800-531-3344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336S0011X
CAPHY501643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0525800OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHA 50164Medicaid
CAPHA 50164Medicaid