Provider Demographics
NPI:1407944952
Name:HOPE MEDICAL SUPPLY
Entity type:Organization
Organization Name:HOPE MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:YINKA
Authorized Official - Middle Name:O
Authorized Official - Last Name:ADEFOWORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-680-9141
Mailing Address - Street 1:1410 3RD ST STE 11
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-3422
Mailing Address - Country:US
Mailing Address - Phone:951-680-9141
Mailing Address - Fax:
Practice Address - Street 1:1410 3RD ST STE 11
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-3422
Practice Address - Country:US
Practice Address - Phone:951-680-9141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44536332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA44536OtherDEPT OF HEALTH SERVICES
CADME03290FMedicaid
CA5579420001Medicare NSC