Provider Demographics
NPI:1811907850
Name:COMPLETE CARE MEDICAL SUPPLY INC.
Entity type:Organization
Organization Name:COMPLETE CARE MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FARAMARZ
Authorized Official - Middle Name:
Authorized Official - Last Name:SAGHIZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-986-9833
Mailing Address - Street 1:16756 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1702
Mailing Address - Country:US
Mailing Address - Phone:818-986-9833
Mailing Address - Fax:818-986-9834
Practice Address - Street 1:16756 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1702
Practice Address - Country:US
Practice Address - Phone:818-986-9833
Practice Address - Fax:818-986-9834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02279GMedicaid
CADME02279GMedicaid