| NPI | 1487320362 |
|---|---|
| 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 |
| 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment | |
| 332BP3500X Durable Medical Equipment & Medical Supplies Parenteral & Enteral Nutrition | |
| Enumeration Date | 2021-08-19 |
| Last Update Date | 2025-03-25 |