Healthcare Provider Details

I. General information

NPI: 1710050307
Provider Name (Legal Business Name): LIFE-CARE HOME HEALTH & MEDICAL SUPPLIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11843 WILSHIRE BLVD
WEST LOS ANGELES CA
90025-6601
US

IV. Provider business mailing address

11843 WILSHIRE BLVD
WEST LOS ANGELES CA
90025-6601
US

V. Phone/Fax

Practice location:
  • Phone: 310-479-0094
  • Fax:
Mailing address:
  • Phone: 310-479-0094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number100335
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberC17635
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number100335
License Number StateCA

VIII. Authorized Official

Name: SHAWN S NAIM
Title or Position: CEO
Credential: CMOF, BOC
Phone: 310-479-0094