Provider Demographics
NPI:1912077306
Name:ALLCARE MEDICAL WEST
Entity Type:Organization
Organization Name:ALLCARE MEDICAL WEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-453-9686
Mailing Address - Street 1:PO BOX 4471
Mailing Address - Street 2:
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91041-4471
Mailing Address - Country:US
Mailing Address - Phone:800-453-9686
Mailing Address - Fax:818-353-8272
Practice Address - Street 1:10117 MCVINE AVE
Practice Address - Street 2:
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040-3360
Practice Address - Country:US
Practice Address - Phone:800-453-9686
Practice Address - Fax:818-353-8272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0002039740-0001-4332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5515520001Medicare NSC