Healthcare Provider Details

I. General information

NPI: 1932464401
Provider Name (Legal Business Name): HANNAH'S MEDICAL AND GENERAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24281 SUNNYMEAD BLVD
MORENO VALLEY CA
92553-3029
US

IV. Provider business mailing address

24281 SUNNYMEAD BLVD
MORENO VALLEY CA
92553-3029
US

V. Phone/Fax

Practice location:
  • Phone: 951-221-1125
  • Fax: 310-217-8825
Mailing address:
  • Phone: 951-221-1125
  • Fax: 310-217-8825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: YVETTE LOUISE HANNAH
Title or Position: OWNER
Credential:
Phone: 951-221-1125