Provider Demographics
NPI:1316127897
Name:LILLIAN MAE CANNADY A J HEALTHCARE SUPPLY
Entity type:Organization
Organization Name:LILLIAN MAE CANNADY A J HEALTHCARE SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:CANNADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-761-4831
Mailing Address - Street 1:7151 LINCOLN AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4613
Mailing Address - Country:US
Mailing Address - Phone:714-761-4831
Mailing Address - Fax:714-761-4833
Practice Address - Street 1:7151 LINCOLN AVE
Practice Address - Street 2:SUITE F
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4613
Practice Address - Country:US
Practice Address - Phone:714-761-4831
Practice Address - Fax:714-761-4833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5121410001Medicare NSC