Provider Demographics
NPI:1134556558
Name:THE CPAP SUPPLY STORE
Entity type:Organization
Organization Name:THE CPAP SUPPLY STORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRIBBEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-625-2727
Mailing Address - Street 1:174 W LINCOLN AVE
Mailing Address - Street 2:SUITE 176
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-2901
Mailing Address - Country:US
Mailing Address - Phone:866-625-2727
Mailing Address - Fax:866-629-7580
Practice Address - Street 1:950 N WINTER ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-1751
Practice Address - Country:US
Practice Address - Phone:866-625-2727
Practice Address - Fax:866-629-7580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies