Provider Demographics
NPI:1780853465
Name:COMFORT LIFE MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:COMFORT LIFE MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MELKONYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-908-0155
Mailing Address - Street 1:15333 SHERMAN WAY
Mailing Address - Street 2:STE L
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-4206
Mailing Address - Country:US
Mailing Address - Phone:818-908-0155
Mailing Address - Fax:818-908-1535
Practice Address - Street 1:15333 SHERMAN WAY
Practice Address - Street 2:STE L
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-4206
Practice Address - Country:US
Practice Address - Phone:818-908-0155
Practice Address - Fax:818-908-1535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6109480001Medicare NSC