| NPI | 1124102207 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY RUSSALESI Cco 484-246-9499 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies |
| Additional Taxonomies | 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2025-10-12 |