Provider Demographics
NPI:1790882835
Name:ADVANCED HOME CARE MED SUPP
Entity Type:Organization
Organization Name:ADVANCED HOME CARE MED SUPP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT COO
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:AFAHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-628-9516
Mailing Address - Street 1:475 N TUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-7778
Mailing Address - Country:US
Mailing Address - Phone:714-628-9516
Mailing Address - Fax:714-628-9764
Practice Address - Street 1:475 N TUSTIN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-7778
Practice Address - Country:US
Practice Address - Phone:714-628-9516
Practice Address - Fax:714-628-9764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
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
4313140001Medicare ID - Type Unspecified