Provider Demographics
NPI:1881733012
Name:AAA1 HEARING AID SERVICES, INC.
Entity type:Organization
Organization Name:AAA1 HEARING AID SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:818-780-1170
Mailing Address - Street 1:17300 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3904
Mailing Address - Country:US
Mailing Address - Phone:818-780-1177
Mailing Address - Fax:818-780-2351
Practice Address - Street 1:17300 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3904
Practice Address - Country:US
Practice Address - Phone:818-780-1177
Practice Address - Fax:818-780-2351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAUD898231H00000X, 237700000X
CAAU2631231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ41642ZMedicaid