Provider Demographics
NPI:1881917425
Name:ADA MEDICAL SUPPLIES INC.
Entity type:Organization
Organization Name:ADA MEDICAL SUPPLIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROZA
Authorized Official - Middle Name:
Authorized Official - Last Name:HONCHAROVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-729-7400
Mailing Address - Street 1:4207 ELVERTA RD STE 103
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-4735
Mailing Address - Country:US
Mailing Address - Phone:916-729-7400
Mailing Address - Fax:877-711-2092
Practice Address - Street 1:4207 ELVERTA RD STE 103
Practice Address - Street 2:
Practice Address - City:ANTELOPE
Practice Address - State:CA
Practice Address - Zip Code:95843-4735
Practice Address - Country:US
Practice Address - Phone:916-729-7400
Practice Address - Fax:877-711-2092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies