=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669420493
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORANGE COAST RESPIRATORY CARE SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2006
-----------------------------------------------------
Last Update Date | 01/25/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 755 S HAYWOOD ST
-----------------------------------------------------
City | WAYNESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28786-4361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-630-1716
-----------------------------------------------------
Fax | 714-630-1694
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1090 N ARMANDO ST
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92806-2605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-630-1716
-----------------------------------------------------
Fax | 714-630-1694
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF OPERATIONS
-----------------------------------------------------
Name | TAMMY ANN FROST
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 714-630-1716
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 02137
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------