| NPI | 1568623759 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANISSA EMANUEL BULLARD Owner 910-735-0500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BP3500X Durable Medical Equipment & Medical Supplies Parenteral & Enteral Nutrition (Licence: NC 00982) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NC 00982) |
| 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment (Licence: NC 00982) | |
| 333300000X Emergency Response System Companies (Licence: NC 00982) | |
| 335E00000X Prosthetic/Orthotic Supplier (Licence: NC 00982) | |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2012-07-23 |