| NPI | 1033491444 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA RENEE HARRIS CEO 618-244-2850 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: IL 203001348) |
| Additional Taxonomies | 332BN1400X Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies |
| Enumeration Date | 2011-09-12 |
| Last Update Date | 2012-02-06 |