Provider Demographics
NPI:1740287317
Name:LIFE CARE HOME HEALTH & MEDICAL SUPPLIES INC
Entity type:Organization
Organization Name:LIFE CARE HOME HEALTH & MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAHRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NAIM
Authorized Official - Suffix:
Authorized Official - Credentials:COMF, BOC
Authorized Official - Phone:310-479-0094
Mailing Address - Street 1:11843 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6601
Mailing Address - Country:US
Mailing Address - Phone:310-479-0094
Mailing Address - Fax:310-477-0999
Practice Address - Street 1:11843 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6601
Practice Address - Country:US
Practice Address - Phone:310-479-0094
Practice Address - Fax:310-477-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME01715GMedicaid
CA0394990001Medicare ID - Type Unspecified