Basic Information
| Provider Information | |||||||||
| NPI: | 1912962879 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AIRCARE HOME RESPIRATORY LLC | ||||||||
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| OtherOrganizationName: | AIRCARE HOME RESPIRATORY, A VERUS HEALTHCARE COMPANY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1569 MALLORY LN BLDG 100 | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370272872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004875566 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13311 GARDEN GROVE BLVD | ||||||||
| Address2: | SUITE D | ||||||||
| City: | GARDEN GROVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004875566 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 09/24/2021 | ||||||||
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| AuthorizedOfficialLastName: | GRIGGS | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4072060040 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | VERUS HEALTHCARE, LLC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BX2000X | 102670 | CA | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |
ID Information
| ID | Type | State | Issuer | Description | DME03121F | 05 | CA | MEDICAID |