Provider Demographics
NPI:1932379245
Name:HOLY CHILD MEDICAL SUPPLY, INC
Entity Type:Organization
Organization Name:HOLY CHILD MEDICAL SUPPLY, INC
Other - Org Name:HOLY CHILD MEDICAL SUPPLY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLAYEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:IRIAFEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-709-4131
Mailing Address - Street 1:8619 RESEDA BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324
Mailing Address - Country:US
Mailing Address - Phone:818-709-4131
Mailing Address - Fax:818-709-1352
Practice Address - Street 1:8619 RESEDA BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324
Practice Address - Country:US
Practice Address - Phone:818-709-4131
Practice Address - Fax:818-709-1352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6147430001Medicare NSC