| NPI | 1366808461 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY RUSSALESI Cco/ AO 484-246-9499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition | |
| 335E00000X Prosthetic/Orthotic Supplier | |
| Enumeration Date | 2016-01-06 |
| Last Update Date | 2024-06-17 |