Provider Demographics
NPI:1700089745
Name:PERPETUAL HOME MEDICAL EQUIPMENT & SUPPLIES, INC.
Entity Type:Organization
Organization Name:PERPETUAL HOME MEDICAL EQUIPMENT & SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:CASTILLO
Authorized Official - Last Name:SISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-388-9560
Mailing Address - Street 1:3018 BEVERLY BLVD
Mailing Address - Street 2:UNIT C
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-1027
Mailing Address - Country:US
Mailing Address - Phone:213-388-9560
Mailing Address - Fax:213-388-9561
Practice Address - Street 1:3018 BEVERLY BLVD
Practice Address - Street 2:UNIT C
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-1027
Practice Address - Country:US
Practice Address - Phone:213-388-9560
Practice Address - Fax:213-388-9561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6009810001Medicare NSC