| NPI | 1669184453 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAVAURUS GOREE Owner 662-321-0703 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2022-12-23 |
| Last Update Date | 2022-12-23 |