Provider Demographics
NPI:1043249196
Name:GENERAL HOME MEDICAL SUPPLY
Entity type:Organization
Organization Name:GENERAL HOME MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KAMBIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:YADIDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-311-0666
Mailing Address - Street 1:717 LAKEFIELD RD STE D
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2692
Mailing Address - Country:US
Mailing Address - Phone:888-311-0666
Mailing Address - Fax:888-611-0666
Practice Address - Street 1:717 LAKEFIELD RD STE D
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2692
Practice Address - Country:US
Practice Address - Phone:888-311-0666
Practice Address - Fax:888-611-0666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76671332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02311GMedicaid
CAGXC018030Medicaid
CADME02311GMedicaid