Provider Demographics
NPI:1538203120
Name:HOLY SPIRIT DME INC
Entity type:Organization
Organization Name:HOLY SPIRIT DME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-962-6288
Mailing Address - Street 1:12711 RAMONA BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:IRWINDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91706-3679
Mailing Address - Country:US
Mailing Address - Phone:626-962-6288
Mailing Address - Fax:626-960-2788
Practice Address - Street 1:12711 RAMONA BLVD STE 108
Practice Address - Street 2:
Practice Address - City:IRWINDALE
Practice Address - State:CA
Practice Address - Zip Code:91706-3679
Practice Address - Country:US
Practice Address - Phone:626-962-6288
Practice Address - Fax:626-960-2788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02158FMedicaid
CADME02158FMedicaid