| NPI | 1699444851 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNMARIE BUCKINGHAM Compliance Supervisor 234-200-1379 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 171WH0202X Contractor Home Modifications | |
| 171WV0202X Contractor Vehicle Modifications | |
| 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | |
| Enumeration Date | 2021-09-10 |
| Last Update Date | 2023-11-03 |