Provider Demographics
NPI:1700801586
Name:MENDO-LAKE HOME RESPIRATORY SERVICES
Entity Type:Organization
Organization Name:MENDO-LAKE HOME RESPIRATORY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-263-9888
Mailing Address - Street 1:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-9917
Mailing Address - Country:US
Mailing Address - Phone:707-263-9888
Mailing Address - Fax:707-263-9889
Practice Address - Street 1:843 PARALLEL DR
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-5707
Practice Address - Country:US
Practice Address - Phone:707-263-9888
Practice Address - Fax:707-263-9889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5736760001Medicare NSC