Healthcare Provider Details

I. General information

NPI: 1689682866
Provider Name (Legal Business Name): RESIDENTIAL MEDICAL SUPPLY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 BANCROFT AVE SUITE 128
OAKLAND CA
94605-2403
US

IV. Provider business mailing address

7200 BANCROFT AVE SUITE 128
OAKLAND CA
94605-2403
US

V. Phone/Fax

Practice location:
  • Phone: 510-553-9159
  • Fax: 510-553-9256
Mailing address:
  • Phone: 510-553-9159
  • Fax: 510-553-9256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1232010
License Number StateCA

VIII. Authorized Official

Name: MR. CHARLES LEE KELLY SEABORN
Title or Position: PRESIDENT
Credential:
Phone: 510-553-9159