Healthcare Provider Details

I. General information

NPI: 1134305972
Provider Name (Legal Business Name): A HOMECARE DEVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5739 YORK BLVD
LOS ANGELES CA
90042-2643
US

IV. Provider business mailing address

PO BOX 21071
GLENDALE CA
91221-5171
US

V. Phone/Fax

Practice location:
  • Phone: 800-757-9797
  • Fax: 323-693-1878
Mailing address:
  • Phone: 800-757-9797
  • Fax: 818-767-1781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberHMDR48741
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberHMDR48741
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberHMDR48741
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number59017
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number59017
License Number StateCA

VIII. Authorized Official

Name: MRS. SHOUSHAN GUKASYAN
Title or Position: CEO
Credential:
Phone: 800-757-9797