Provider Demographics
NPI:1407092240
Name:APPLE WEST HOME MEDICAL SUPPLY
Entity type:Organization
Organization Name:APPLE WEST HOME MEDICAL SUPPLY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, PATIENT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DALLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-401-2628
Mailing Address - Street 1:2230 TOWNE LAKE PKWY
Mailing Address - Street 2:BLD. 200 STE. 100
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5548
Mailing Address - Country:US
Mailing Address - Phone:678-401-2628
Mailing Address - Fax:877-832-9663
Practice Address - Street 1:1122 DAVIS ST
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-2500
Practice Address - Country:US
Practice Address - Phone:510-868-9175
Practice Address - Fax:855-380-4834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA123512OtherSTATE OF CALIFORNIA HOME MEDICAL DEVICE RETAIL LICENSE
TX1000845OtherTEXAS DEVICE DISTRIBUTOR
CA51472OtherHOME MEDICAL DEVICE RETAIL LICENSE