Provider Demographics
NPI:1205876935
Name:MEDCO HOME HEALTHCARE INC
Entity type:Organization
Organization Name:MEDCO HOME HEALTHCARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERLINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHOMMALAYVANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-476-1992
Mailing Address - Street 1:11010 ARROW RTE
Mailing Address - Street 2:#109
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4826
Mailing Address - Country:US
Mailing Address - Phone:909-476-1992
Mailing Address - Fax:909-476-7747
Practice Address - Street 1:11010 ARROW RTE
Practice Address - Street 2:#109
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4826
Practice Address - Country:US
Practice Address - Phone:909-476-1992
Practice Address - Fax:909-476-7747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5181340001Medicare NSC