Provider Demographics
NPI:1063569606
Name:FAME HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:FAME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANUGOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-779-7916
Mailing Address - Street 1:10710 AVALON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90061-2522
Mailing Address - Country:US
Mailing Address - Phone:323-779-7916
Mailing Address - Fax:323-779-7916
Practice Address - Street 1:10710 AVALON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90061-2522
Practice Address - Country:US
Practice Address - Phone:323-779-7916
Practice Address - Fax:323-779-7916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46271332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA46271OtherHMDR
CA46271OtherHMDR