| NPI | 1407253560 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY MATUKEWICZ Secretary 423-756-2268 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 171W00000X Contractor |
| 171WH0202X Contractor, Home Modifications | |
| 171WV0202X Contractor, Vehicle Modifications | |
| 225CA2500X Rehabilitation Counselor, Assistive Technology Supplier | |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: IA 1-77-105931) | |
| Enumeration Date | 2014-12-04 |
| Last Update Date | 2023-06-09 |