Healthcare Provider Details

I. General information

NPI: 1629381207
Provider Name (Legal Business Name): A HOMECARE DEVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 07/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 MARTIN LUTHER KING JR BLVD STE 106
LYNWOOD CA
90262-3524
US

IV. Provider business mailing address

PO BOX 21071
GLENDALE CA
91221-5171
US

V. Phone/Fax

Practice location:
  • Phone: 310-537-9977
  • Fax:
Mailing address:
  • Phone: 310-537-9977
  • Fax: 323-693-1878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. VARTAN MARTIN GUKASYAN
Title or Position: GENERAL MANAGER
Credential: ATP, OT, EXEMPTEE
Phone: 310-537-9977